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Higher Education Is a Public-Health Issue

By GORDON K. DAVIES, president of the Kentucky Council on Postsecondary Education

Higher education has an enormous responsibility for our society's well-being. Policy makers often highlight higher education's critical importance to local, state, and national economies. Education beyond high school is now a necessity for most people who aspire to be financially secure.

Yet beyond their economic contributions, colleges and universities play another closely connected but often overlooked role -- one that is gaining new urgency. Education determines not only earning capacity but also the very quality of human life. Even longevity is correlated with educational achievement. In the broad sense of how well we live our lives -- both individually and collectively -- higher education is a public-health issue.

My home state of Kentucky -- and, I suspect, every other state -- has its regions of poverty, children trapped in bad schools, adults who lack the skills needed to earn a decent wage, chronic patterns of behavior that lead to debilitating diseases, and clusters of people without a shared purpose to unite them as communities. Underlying the differences among the states are common public-health needs. Higher education is an essential part of the cure.

Try this in your state: On a map, identify counties, cities, or regions that have major educational problems such as large numbers of students dropping out of high school or small percentages of that population attending colleges. Overlay that map with another that identifies areas with low per-capita income and high unemployment. Add another map showing excessive concentrations of above-average rates of lung cancer and coronary disease, then another indicating excessive concentrations of infant mortality and children living in poverty.

In Kentucky we found, not surprisingly, that the maps overlapped significantly. Chances are, your state has similar overlaps. Education, or lack of it, relates to every other social issue.

The ability to put roses as well as bread on the table is essential to a full life. Parenting and other personal relationships, civic and community involvement, creation and use of leisure time, care of self and loved ones, the ability to do one's work and comprehend its meaning in society -- reasonable competence in at least most of these things is essential to our personal and collective health.

Those of us with more education tend to have higher incomes and can afford better health care and insurance. Higher education also gives us greater awareness of how we and our children can be healthy and reduce risks. For example, we know from medical research that better-educated women have easier pregnancies and are apt to bear healthier children. We also know that they receive better medical care.

Educated people know how to change their behavior. Harry Carloss, the outgoing president of the Kentucky Medical Association, observed in the association's journal that the five-year survival rate of college-educated patients with breast cancer is double that of those who lack a high-school diploma. Education, he concluded, influences all conditions in which behavior modification can yield positive results. Confidence, self-reliance, and adaptability are all earmarks of advanced education.

Research shows that a strong contributing factor to a child's ability to read is parents who read with her. Studies also demonstrate that the single strongest predictor of whether a young person will go to college is that her parents attended.

Kentucky is working hard to overcome severe educational deficits. Almost one-third of ninth-graders drop out by the end of12th grade. Only about half of those who graduate from high school go on to college. Of the people who enroll in Kentucky's public universities, barely 4 in 10 graduate within six years. The ratio of engineers and scientists to the general population is among the lowest in the nation. Almost 1 million people in the workforce of 2.4 million have trouble with reading and arithmetic.

Kentuckians also tend to be unhealthy. They suffer disproportionately from diabetes, heart disease, and cancer. They have myriad bad health habits that cause or contribute to illness. We are, for example, second among the states in the percentage of adults who smoke. A survey conducted by the University of Kentucky in 2000 showed that the probability of smoking is inversely related to educational achievement.

The educational deficit and generally poor health among Kentuckians affect communities, families, and individuals. For more than 20 years, Kentucky's per-capita income has remained at about 81 percent of the national average, among the lowest in the nation. But that isn't just a matter of money. It also is a matter of personal and community well-being.

Building strong colleges and universities does not lead automatically to a healthier citizenry. When Kentucky began its ambitious reform of postsecondary education in 1997, the state ranked 40th in Kids Count, the annual assessment of how well children are doing in the United States. But just ahead of Kentucky, in 39th place, was North Carolina, a state that has one of the nation's best systems of higher education as well as a good community-college system.

It is possible to build and maintain fine educational institutions while disregarding the condition of children. Indeed, it is possible to build them while not responding to the needs of children and others who are voiceless and easily ignored.

For example, Kentucky's spending on higher education is very high -- 12th among the states per full-time-equivalent student in 1999. But by most indicators of personal and collective well-being, we rank among the bottom 10 states. The reform effort now underway challenges us to improve the return on the state's investment. If we cannot, perhaps public money should be spent on services other than higher education.

Higher-education institutions already improve the general health of communities and individuals in many ways. Colleges and universities train physicians and other health-care professionals. They operate clinics in remote regions of every state, and participate in efforts to vaccinate children and ensure that they have health insurance. They help farmers find alternatives to crops like tobacco and increase the efficiency of small farms. They provide incubator space and management advice to small businesses.

But the needs are much greater. We should help parents and future parents become more self-reliant, skillful, and capable of raising children who expect to go to college and are prepared to do so. We should offer education that provides adults with the skills and knowledge they need to prosper in a technologically advanced economy. And we should reward faculty research that can be transformed into new industries and better jobs in our states.

If we build great universities and do not at the same time help improve the lives of every woman, man, and child -- even those who do not participate in advanced education -- we shall have failed. We shall have built our castles in a bog.

We should not turn our colleges and universities into social-service agencies. But we do need to recognize publicly that advanced learning is a key ingredient of personal and community health. We know that state health agencies cannot wait passively for parents to bring their children for vaccinations; too many never make it. We should be no more complacent about large numbers of students dropping out of high school or not going on to college than we are about vaccinations. Our state policy should be zero high-school dropouts and 100 percent participation in some form of advanced education among recent high-school graduates.

We can't sustain economic growth based on technological sophistication if one-third or more of the adult workforce reads, writes, and computes poorly, if at all. We can't sustain a democratic, participatory form of government if large numbers of African-American, Hispanic, and poor white students drop out of school before they have learned how to be good citizens.

If we focus only on results within our immediate control, we shall miss an opportunity to transform our society. Those of us in higher education possess a moral authority that enables us to lead society on crucial issues. Colleges and universities are the best institutions to accept responsibility for public health in the broadest sense.

In his 1876 inaugural address as the first president of the Johns Hopkins University, Daniel Coit Gilman predicted that the advent of the modern research university would lead to "less misery among the poor, less ignorance in schools, less bigotry in the temple, less suffering in the hospital, less fraud in business, less folly in politics." Gilman's vision is easy to dismiss as a naive expression of 19th-century liberalism. But it also is a generous and courageous statement of the social responsibility of colleges and universities in a democratic society. Cynicism about such lofty goals as reducing the folly in politics should not blind us to the great contributions higher education has made -- and should continue to make -- to improve the public health.

As the most privileged institutions of our society, colleges and universities should reaffirm and work toward achieving Gilman's vision. We need educational leaders who assert that the health of individuals and communities -- the public health -- is the responsibility of their institutions, and who help faculty members and administrators achieve a broader vision of what advanced education has come to mean in our world.


  • First, we should become much more involved in preschool, elementary, and secondary education. Because decisions made early in life profoundly affect later opportunities, we should acknowledge every young person as too valuable to waste and treat each as a potential learner. We should fill in the ugly ditch between high school and college so the transition is not an obstacle to continued learning. We should invest more time and energy in preparing teachers and improving the status of teaching as a profession.
  • Second, we should help educate the tens of millions of adults who can't read well enough to follow the instructions of a family physician, who barely qualify to work in the fast-food industry, and who lack the capacity to adapt their behavior when the conditions of their lives change because of illness, job loss, or countless other incidents. We should reach out to people who are isolated by geography or personal circumstances. For example, Kentucky is using its Virtual University to fight adult illiteracy and train 911 operators and volunteer firefighters, as well as to make the collections of every college and university library accessible to patrons of public libraries throughout the state.
  • Third, we should affirm and demonstrate within the curriculum the practical value of learning. We should require all students to participate in community service that is relevant to their programs of study. We should remind society -- and ourselves -- that politics and economics are best understood in the context of the classic philosophical debate about how to live the good life.
  • Above all, we should model the behavior we want. Students often experience a curriculum that is very different from the one we think we are teaching; they learn more from what we do than from what we say. Leaders who are willing to be judged on whether the quality of lives actually improves as a result of theirefforts, not just on whether they have cracked this or that elite ranking, will make an enormous difference.

Helping improve public health is important because it's practical and necessary, not just because it's the right thing to do. State governments that invest in higher education should expect returns on their investments that transcend the institutions themselves: healthier individuals, social institutions, and communities. Wilhelmina Delco, now retired from the Texas legislature, used to say that state investments in higher education had to make a difference to all citizens, whether they attended college or not.

"Perhaps we cannot make this a world in which children do not suffer," wrote Albert Camus. "But we can lessen the number of suffering children. And if you and I do not do this, who will?" That is the challenge of seeing higher education as a public-health issue.

This article is from The Chronicle of Higher Education (http://chronicle.com) From the issue dated November 30, 2001.


2003 Legislative Summary

These bills did not pass but could return in 2004

Child Booster Seats:

HB 274 would have required all drivers transporting a child between 40 inches and 4 feet, 9 inches in height, and weighing less than 80 pounds, to have the child secured in a child booster seat that meets federal safety standards. The bill passed the House and the Senate Transportation Committee. It has a significant chance for passage in 2004. It would apply to all children transported by schools.

Childhood Obesity Prevention:

HB 77, the bill proposing limits on soft drink sales, regulation of fat and sugar content of drinks and snack foods, 30 minutes of mandatory daily physical activity for students, and training requirements for food service directors, was defeated again this year. The General assembly passed an amendment that eliminated the physical activity mandate. The bill died when it was sent to an "unfriendly" Senate Committee.

Firearms/Signage Posting:

HB 482 would have required that signs relating to unlawful possession of a weapon be posted at the entrances to all school buildings and at the perimeter of all school-owned property and open spaces. The bill passed the House. It was not heard in the Senate. HB 207 would have changed the size requirements for signage currently posted related to unlawful possession of a weapon. The bill was withdrawn.

Funding Health Insurance Benefits for Classified Retirees:

In its original version, HB 103 would have required cities and counties to pay an annual fee for each employee not participating in the Kentucky health insurance pool. This supposedly would lower health insurance rates for state employees by $5 per employee per month and come at a cost of approximately $100 per city and county employee. The bill was a result of an interim study of strategies to lower health insurance costs. The bill was never called for a vote in the House. It is CERTAIN to return in 2004.

Individual Care Plans for Students:

HB 76 would have required schools to develop individual care plans for students with diabetes. HB 378 would have required schools to develop these plans for students with any health condition that might impact their safety at school. The bills were not heard. It is uncertain whether or not they will return in 2004.


SB 220 would have eliminated the Office of Education Accountability and transferred its investigative function to an Inspector General housed at the Kentucky Department of Education. The bill passed the Senate and was heard in the House State Government Committee in the final days of the session. It is likely to return in 2004.

New Laws

Senate Bills

HB 132 (Sen. Casebier)

Increases stopping distance for school buses at railroad crossings from 15 feet to 50 feet from the nearest track. If visibility is impaired at 50 feet, the driver can then allow the bus to roll slowly forward. Also, an amendment was attached with an emergency clause adding that the Commissioner of Education can approve five disaster days for a school district that has been closed at least ten days. Certified personnel shall continue to report to work and participate in instructional activities or professional development during the five disaster days. The Department has stated that the five disaster days allowed by SB 132 cannot be counted as equivalent time. Effective immediately.

SB 154 (Sen. Casebier)

Requires a program to promote the integration of the arts and foreign languages into elementary school programs by awarding a grant distributed to one school per region. $500,000 was provided in FY '04 to fund an Elementary School Arts & Foreign Language program. No funding was provided for FY '03. KDE is directed to establish a program that promotes integration of arts and foreign languages into the elementary school curriculum. Schools would submit an application for funds through the superintendent with approval of the council (or principal if no council exists). The budget directs KDE to award at least one grant per region based upon the quality of the applications in meeting the criteria set forth in the budget bill.

SB 156 (Sen. Casebier)

Requires the Kentucky Missing Child Information Center to provide the Commissioner of Education with information on missing and recovered children. The Department of Education would distribute to schools each week a list of names of all missing and recovered children. Schools would have to notify the Kentucky State Police of any contact with a missing child, a request for school records of a missing child, and non-compliance of providing proof of a child's identity by a person enrolling the student in school.

House Bills

HB 95 (Rep. Butler, Embry & Nelson)

Permits an employee covered by the state health insurance group to select coverage in a county adjacent to his county of residence if neither his home county nor work county has a hospital that provides certain services and the county adjacent to his county of residence has a hospital with those services.

HB 328 (Rep. Westrom & Palumbo)

Authorizes not-for-profit primary care centers licensed under KRS Chapter 216 (which is a participant in the Kentucky Patient Access and Care System of the Department for Medicaid Services) to enter into a written agreement with boards of education to provide a school-based health care program.

The Legislative Research Commission was unable to determine associated costs because the number of primary care centers that would enter into a written agreement with a local board of education to provide a primary care center within the school setting after August 1, 2004 was indeterminable. No projections on the number of students who may participate or be served were produced nor the type of service they may receive from such a primary care center.

Some students who may be served by a primary care center within a school setting may also be Medicaid eligible, resulting in a potential fiscal impact on the Medicaid program. Additionally, local boards of education that may wish to enter into such an agreement may not have available infrastructure (i.e. building space) to support a primary center within the school setting.

HB 398 (Rep. Callahan)

Establishes a Safety Education Fund to be administered by the Commission on Fire Protection Personnel Standards and Education to initiate education programs in public schools and other agencies to reduce and prevent injuries and the loss of life. The Commission will promulgate administrative regulations to establish the criteria for providing funds to initiate injury prevention curricula and training programs throughout the state.

HB 269 (Budget bill)

Contained within HB 269 is a provision for the Reserve Officers Training Corps: Under provisions of KRS 156.160, the Kentucky Board of Education shall include in the courses of study for students provisions that preparation in the Reserve Officers Training Corps shall meet the physical education requirement for high school graduation.

2002 Legislative Summary

SB 113 - D. Boswell

AN ACT relating to death certificates.

Amend KRS 213.076 to require diabetes to be listed in the appropriate location on a death certificate if diabetes was an underlying cause of death or a contributing condition.


SB 113 -Amendments

1. SCS - Provide that person completing death certificate answer "yes" or "no" as to whether deceased had diabetes and whether diabetes was a contributing or underlying cause of death; require Cabinet for Health Services to include questions about diabetes on the death certificate form; and require the state registrar to call attention to any defects in answering the questions to allow the person to correct the defects.


SB 142 - J. Denton

AN ACT relating to adult day health care.

Create a new section of KRS 205.510 to 205.645 to require adult day health care programs to provide skilled nursing services to Medicaid recipients during posted hours of operation only.


SB 142 - Amendments

1. HCS - Retain original provisions and amend KRS 156.070 to require each local board of education to require an annual medical examination performed by a physician, physician assistant, advanced registered nurse practitioner, or chiropractor for a student seeking eligibility to participate in interscholastic athletics and prohibit the State Board of Education or other agency from promulgating administrative regulations to the contrary.

2. HCA - Make title amendment


SB 196 - L. Caspier

AN ACT relating to emergency medical services.

Amend KRS 311.658 to permit emergency medical technician-basic providers and paramedics to administer epinephrine for allergic reactions under medical protocol of the licensed ambulance service; create a new section of KRS 311.652 to 311.658 to require ambulance providers to stock epinephrine and administration supplies on ambulances and to establish medical protocols for treatment of allergic reactions.


SB 196 - Amendments

1. HFA - Permit an ambulance provider or EMS provider to refuse to transport from 1 medical facility to another a patient who has presented with a mental condition that has involved a physical or verbal threat to the patient or to any other person.

2. HFA - Attach provisions of HB 359 except for provisions creating civil penalty for non-compliance.

3. HFA - Make title amendment


SB 207 - L. Caspier

AN ACT related to vision examinations for children entering public school, public preschool, or Head Start programs.

Amend KRS 156.160 to clarify that vision screening examinations must be performed and submitted to the public school, public preschool, or Head Start program when a child between the ages of 3 and 6 years old is enrolled for the first time.


HB 126 - M. Marzian

AN ACT relating to the provision of health care services in the schools.

Requires the Department of Education, (KDE) in cooperation with the Department for Public Health (KDPH), to provide, contract for services or identify resources for the improvement of student health services, including standardized protocols and guidelines for health procedures to be performed by health professionals and school personnel; consultation, technical assistance and development of quality improvement measures for boards of education and health departments; facilitation of state and local data collection and reporting of health services; and information on providing health services. Establishes a position to assist in carrying out the responsibilities of the Act shared by the KDE and KDPH through a memorandum of agreement; defines "health services" and "school employees" and requires that health services be provided by a physician or a licensed nurse or a school employee who is delegated responsibility by a physician or nurse to perform the service and has received training and approval in writing, with the delegated responsibility valid for the current school year; requires the district to make arrangements for health services to ensure student attendance or participation until appropriate school personnel is delegated responsibility if no school employee is trained and approved; grants a school employee properly delegated the responsibility protection from liability under federal law unless actions are determined willful, criminal, or flagrant indifference to rights and safety of others; requires the KDPH to provide information, assistance and support to the education school nurse consultant and the KDE; and prohibits duplication of services or duties between KDE and KDPH.


HB 279 - B. Crall, T. Burch, M. Denham

AN ACT relating to death certificates.

Amend KRS 213.076 to require diabetes to be listed in the appropriate location on a death certificate if diabetes was an underlying cause of death or a contributing condition.


HB 353 - M. Marzian, S. Westrom, J. Jenkins

An ACT relating to access to asthma medications in schools.

Create new sections of KRS Chapter 158 to permit public and private school students to self-administer asthma medications when the school receives written authorization from the parent and health care provider; requires statements to be kept on file at the school; require parent or guardian to sign a statement acknowledging that the school has no liability from any injury sustained by a student from self-administration of medication; require permission to be effective for the school year and renewed each school year; require administrative regulations promulgated by the state board of education to implement requirements for public schools; permit self-administration of asthma medication prior to promulgation of administrative regulations.


HB 353 - Amendments

1. HFA - Retain original provisions except delete requirement for the Department of Education to promulgate regulations.

2. SCA - Remove reference to administrative regulations.


HB 484 - R. Thomas, S. Riggs

AN ACT relating to state purchases of food or beverages.

Establishes a purchasing preference in state purchasing contracts for high calcium foods or beverages to require programs operated in schools, preschools, and day care facilities to purchase calcium-enhanced foods and beverages when those products cost no more than similar products.


HB 593 - R. Adkins, K. Hall

AN ACT relating to high school athletics.

Amend KRS 156.070 to prohibit the agency designated to manage interscholastic athletics from scheduling the semifinals and the finals of any high school basketball tournament on the same day.


HB 593 - Amendments

1. HCS - Eliminate the original provisions of the bill and establish a study group composed of educators, private citizens, and two legislators to review the current format of the high school state basketball tournaments and make recommendations prior to scheduling the 2003 - 2004 tournaments.

2. HFA - Require that committee appointed to study high school basketball tournaments be equally represented by males and females.

3. HFA - Require that the committee appointed study high school basketball tournaments be equally represented by males and females, except for appointments representing the KHSAA board of control and the General Assembly.

4. HFA - Add a provision to amend KRS 156.070 to permit a high school team to compete at a classification higher than the classification level based on enrollment requirements under specific approval process.


2001 Legislative Summary

HB 1 An Act relating to crimes and punishments

Create crimes of terroristic threatening in the first and second degree for making false statements about placing a weapon of mass destruction on school property or threatening to commit an act likely to result in death or serious injury to those on school property or attending school functions.


HB 62 An Act relating to tuition assistance

Require public postsecondary institutions to wave tuition and mandatory student fees for a Kentucky foster or adopted child who is a full-time student. Require that an eligible student meet all entrance requirements for the postsecondary institution and maintain academic eligibility while enrolled at the postsecondary institution. Prohibit guaranteed acceptance of or entrance of a student into any postsecondary institution for a foster or adopted child.


HB 191 An Act relating to high school athletics

Deletes varsity wrestling from the list of prohibited high school varsity sports for seventh and eighth grade students; stipulates that if non-teaching personnel are allowed to coach sports then they must be allowed to coach all sports, including football and basketball; gives preferences to certified personnel applying for the coaching position if non-teaching coaches are allowed.


HB 204 An Act relating to criminal records check

Exempts students in an educational institution who observe or participate in educational activities under the supervision of a teacher or administrator for the criminal records check requirement; require student teachers to have criminal records checks.


SB 108 An Act relating to the school term

Require school districts to adopt a school calendar designating opening and closing dates and instructional days; authorizes scheduling of school breaks outside the minimum school term; require schools to allow teacher delegates to attend statewide professional meetings and hire substitute teachers if schools are scheduled to operate on meeting days; requires school districts to arrange bus schedules so that breakfast is provided prior to the instructional day; permits a school administrator in the event of an unforeseen bus delay to authorize up to fifteen minutes of the instructional day to provide children the opportunity to eat breakfast, not to exceed eight times during the school year within a school building.



2000 Legislative Summary

HB 157 - Representative Robert Damron

AN ACT relating to character education. Defines "character education"; adds core values and qualities of good character to make moral and ethical decisions in life to the capacities students will be assisted in acquiring by the system of public education; requires schools to develop their students' ability to become self-sufficient individuals of good character; requires the Kentucky Board of Education to include strategies to incorporate character education throughout a school's curriculum in the state model curriculum framework; adds strategies to incorporate character education throughout a school's curriculum to the areas that may be covered by optional professional development programs provided by the Kentucky Department of Education; specifies that character education programs and activities be considered components of actual school work constituting a school day; adds the development of core values and qualities of good character to the list of training needs for students to be included in school safety and student discipline assessments.


HB 564 - Representative Ruth Palumbo

AN ACT relating to immunizations. Requires immunization certificate for hepatitis B for sixth grade children within two weeks of the child's attendance; authorizes the Cabinet for Health Services to promulgate administrative regulations; sunsets the requirement following the 2008-2009 school year. This requirement is expected to be effective for the 2001-2002 school year, which typically begins in August for most Kentucky Schools.



HB 640 - Representative Frank Rausche, et al.

AN ACT relating to family resource and youth services centers and declaring an emergency. Requires the eligibility criteria for locating family resource and youth services centers to be based on the school population qualifying for free or reduced price school meals; requires that grant program funding to the Cabinet for Families and Children include an increase equal or greater than the general fund growth factor provided in agency budget instructions; requires local districts to provide the same salary rate adjustment for classified employees of centers as provided for other local board of education employees in the same classification.



HB 706 - Representative Tom Burch, et al

AN ACT relating to early childhood development. Establishes community early childhood councils in each service area to include representatives of family resource centers and school districts to develop a needs assessment and budget proposal; requires a vision examination for all students upon admission to public schools or by January 1 following entrance to Head Start, preschool or primary, or first-time entrance to the public schools; repeals the Kentucky Early Childhood Advisory Council.



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