(From the ISHN Member information service)  A background paper on metrics (monitoring, reporting, indicators and data sources) has been prepared for the US National Collaborative on Education and Health (NCEH) Published in August 2014 which describes current US state and federal efforts to include health data in school monitoring and reporting systems.  This ISHN commentary includes several excerpts from the paper followed by some brief comments on how the analysis can be extended to delve deeper into the relationship between health and education systems.

Selected Excerpts: 
'With the passage of the Elementary and Secondary Education Act (ESEA) as reauthorized by No Child Left Behind of 2001, states are now required to provide report cards for all public schools, which must include information about students’ performance on standardized tests, as well as whether schools have been identified as needing improvement, corrective action, or restructuring. Student data must be dis-aggregated by student subgroups according to race, ethnicity,gender, English language proficiency, migrant status, disability status and low
-income status. These report cards must be made public online and through other mechanisms. Some Local Education Agencies use this opportunity to share comprehensive data about schools in the district, particularly contextual data on issues that are strongly correlated with academic achievement, including teacher qualifications, school climate and safety, and commitment to health and wellness. States also have laws requiring that schools report other data, such as school safety (e.g., Virginia and Oklahoma) or the condition of school facilities (e.g.,
Pennsylvania). Finally, Illinois and Colorado have state laws that require the schools to report on health and wellness data, including access to recess, physical education and access to school health services.  

For the past two decades, states have been creating and refining longitudinal data systems to track, store, analyze, and apply a range of data to improve academic achievement and student outcomes. These State Longitudinal Data Systems (SLDS) allow states to track and monitor a student’s data from one grade to the next. In addition, most of the data reported in state school report cards comes from SLDS. While states generally do collect individual student data on health conditions that are correlated with academic achievement, such as a
ctive asthma, vision problems, or dental caries via school health services or required state school health forms, these data are not commonly tracked longitudinally or linked with a student’s academic data. California represents one example of a state that is using a longitudinal data system, the California School Climate, Health and Learning System, to collect information about both education and health." (Note: Later in the report, brief summaries of other states doing similar reporting are provided. These include Oregon, Texas, Colorado and Illinois,)

Although health has not traditionally been collected in SLDS, there is a precedent for collecting non-academic student data in SLDS to inform and develop educationally relevant interventions. Examples such as these can provide a framework for how health can inform and enrich SLDS
to create more robust student interventions. For example , some states have used their SLDS to establish an Early Warning System that can be used to identify students at risk of dropping out by tracking attendance, behavior and course success. According to
the Data Quality Campaign, in 2013, 26 states had an Early Warning System that they were using to identify students who might be at risk of dropping out. "

The report also examines recent efforts by the US Department of Education to monitor student health and wellness. "The National Center on Safe Supportive Learning Environments (NCSSLE) is funded by the U.S. Department of Education’s Office of Safe and Healthy Students and seeks to improve schools’ conditions for learning through measurement and program implementation, so that all students have the opportunity to realize academic success in safe and supportive environments.A key activity of the NCSSLE is to provide support to 11 grantees
that are working to address factors that affect conditions for learning and impede the building and maintenance of safe and supportive learning environments (e.g.,bullying, harassment, violence, substance abuse). Specifically, these grantees are in the process of implementing programs
or developing initiatives to collect and use data to assess the extent to which schools are safe and supportive. NCSSLE also maintains a compendium of valid and reliable surveys, assessments and scales of school climate. 

Commentary: 

This NCEH background paper provides a good overview of the efforts of some states and the recent federal work to include health data in education monitoring and reporting systems. It provides a description of current education state education department activities in monitoring their system results and how some health data can be included. 

However, the paper does not mention the well-developed system for reporting on student health and on system capacity that has been developed by the Centers for Disease Control and Prevention, including the Youth Risk Behavior Survey, the School Health Policies and Practices Survey and the various other "profile" reports that CDC publishes. The activities from the education system could be combined with the existing monitoring and reporting systems  that have been well developed by CDC. The YRBS data is available by state. The SHPPS data would provide much of the policy/program data required to complete the picture. 

As well, the US is one of 43 countries participating in the Health Behaviors of School-aged Children (HBSC) survey, a long-standing international survey done regularly by countries in western Europe and Canada that tracks student health behaviors as well as the social support provided by parents, peers and schools. In particular, the HBSC survey offers excellent data on the "connectedness" between students and their teachers and schools, a key factor in school success. 

Further, the discussions and initial framework for Monitoring & Reporting Systems developed by the International Discussion Group on MRE led by the International School health Network suggests that in addition to tracking health status/behaviours and system policies/programs, an effective M&R system needs to include data on the learning outcomes achieved by students in health, family studies, personal/social development and physical education. although a couple of US states have considered the development of such additions to their tracking of the learning occurring in other core subjects such as language arts, math and science, there is no system in the US (or any other country) for reporting on student learning in these areas. )Note: The report does discuss student learning somewhat noting that " Most states, for example, have standards for physical and health education. Some states assess student progress on meeting these standards using statewide tests, allowing a statewide comparison and analysis of scores." However, the examples cited in this section in the report such as the Fitnessgram used in California and Texas actually measure health status (fitness levels) rather than what has been learned in PE classes.)   

This initial NCEH report could be extended or elaborated upon so that the development of metrics (indicators, data sources and monitoring/reporting systems) is based on a truer, more appropriate relationship between health and education systems. Rather than starting with the concerns of health systems (or by using the readily available data sources), the process could begin with identifying the health and social issues/factors that are most relevant to student learning and school success. Charles Basch, in his work on health equity and schooling in the US, has identified several health problems that have a significantly more impact on educational success. These include eating breakfast, hungry children/school meal programs, teen pregnancies causing school dropouts, homophobic and other forms of bullying, dental health, head lice, asthma and others that cause prolonged absences from school. By starting with these health and social issues, the process becomes more of a support to educators and their primary mission, rather than adding more items for which schools become implicitly accountable (since they are often the only ones reporting on the health and well-being of children on a regular basis). This new premise is part of a US/Canada and global dialogue on how health (and other systems) can fit better within the core mandates, concerns and constraints of school systems. Using this integration within" premise, rather than "adding to" or even "aligning" the metrics of the two systems offers the promise of more engagement and more sustainable support from educators and the systems in which they work.      

(An item from the ISHN Member information service) All too often we see government ministries and officials avoiding comparisons of the various surveys of child/youth health and policy/programs. while comparisons over time of the situation in one country or state/province are the best data to examine, reasonable comparisons among similar jurisdictions can also be very useful. We see and example of this in an aticle in Issue #5, 2013 of Australian & New Zealand Journal of Public Health. The article reports on a comparison of child unintentional injury deaths in New Zealand compared to 25 European countries. The overall ranking is provided but that is less important than the fact that the comparison identifies "A set of injury prevention policy and legislation priorities are presented which, if implemented, would result in a significant reduction in the injury mortality and morbidity rates of NZ children."  Read more>>

(An item from ISHN Member information service) An article in Issue #6, 2012 of Policy Development Review describes a shift in thinking about monitoring and evaluation in low income countries. The article is described as "An important first step in any initiative involving M&E capacity development is the diagnosis of the systems' current status. This article presents a diagnostic checklist that captures issues of M&E policy: indicators, data collection and methodology; organisation; capacity-building; participation of nongovernmental actors; and use. It applies it to a review of the PRSP M&E arrangements of 20 aid-dependent countries in sub-Saharan Africa to demonstrate comparative strengths and weaknesses". Read More.