COD E R E D

School-BasedInterventionsTable 3Table 4AcademicPerformanceTable 2Child HealthStatusEducationalAttainmentAdult HealthStatusTable 5The illustration above highlights the main linkages that make up the cycle. The childhood portionappears on the left of the cycle and the adult portion on the right. As noted earlier, our review of theevidence for these linkages concentrates on the relationships between health and education for childrenand adults and on school-based interventions on the childhood portion of the cycle. The table numbersappearing near the arrows in the figure correspond to our summary tables of findings from the scientificliterature that will appear in subsequent sections of this report.Our overall strategy in the first of three parts is to review all of the published, scientific literaturerelevant to each of the childhood links, paying special attention to the evidence that identifies interventionsproven to work. Certainly, the weight of the evidence will vary with the number and quality of thepublished studies; in some instances, where much has been made of certain links, we will find thatsupporting evidence simply does not exist. Such interventions, supported largely by inference andreputation, seem to take on a life of their own. In other instances, simple, relatively inexpensiveinterventions will be shown to yield large dividends in academic performance. Our assessment will beordered according to the prevalence of chronic, childhood health conditions. The link between thesechronic conditions and academic performance will be considered first. The second link of interest isbetween school-based interventions and these chronic conditions; that is, we consider whether anythingcan be done during the school day to alleviate these conditions. Finally, we consider whether thesehealth-oriented interventions are proven to make any difference for academic performance. Breaking thecycle depends upon it.Part Two turns attention to the adult portion of the cycle, reviewing the extensive evidence relevantto the link between educational attainment and health status in adulthood. This represents one of themost thoroughly documented of the links, at least in the health literature. To the extent that compromisedacademic performance in childhood impinges on overall educational attainment, affecting, say, high schoolcompletion or the pursuit of an advanced degree, then we are led to expect compromised health status inadulthood. Because of time and space constraints, however, we have not reviewed the extensiveevidence linking academic performance to overall educational attainment. Similarly, the evidence linkingparental educational attainment and health status to the health status of their offspring will have to awaitassessment on another occasion.Part Three shifts away from an examination of the evidence behind the various links betweeneducation and health to consider the issue of policy recommendations. Literally, hundreds ofrecommendations have been generated in more than 50 reports just in the last five years. The impetus forthese has come from widespread perception of relatively dramatic increases in the prevalence of certainchildhood conditions, most notably, obesity, Type II diabetes and asthma. Fortunately, for analyticalpurposes, the recommendations can be quickly pared down since few are supported by substantialevidence of success, and fewer still have been shown to make a difference for the academic achievementE-2