Chronic Absenteeism Is a Vital Sign for Kids’ Health. New Framework Seeks a Cure

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When we worked in clinics caring for families and children, we routinely measured vital signs like blood pressure and heart rate and growth metrics like height and weight. But one of the most important health indicators remained out of reach: whether the kids were regularly showing up in school.

School attendance is critical for success in the classroom, and success in school is core to health across a lifespan. Children who attend school regularly are far more likely to achieve academically and graduate from high school than those who are chronically absent. In turn, high school graduation leads to better health outcomes, and students who graduate are more likely to have fewer chronic illnesses and fewer injuries, and live longer lives, than those who do not.

Yet today, more than 1 in 4 American students is chronically absent, defined as missing more than 10% of school days. In some districts, that proportion is closer to 1 in 2. The COVID pandemic widened and deepened a longstanding problem, and now, the obstacles that prevent children from coming to school — chronic illness, disengagement in the classroom and unmet social needs — are wide-ranging. While many teachers and principals have worked tirelessly to get students back into the classroom, chronic absence has become a problem too big for educators or schools to solve alone. 

A new public health framework, developed by education and public health experts at Johns Hopkins Bloomberg School of Public Health, Kaiser Permanente and Attendance Works, offers a comprehensive, community-driven approach with three core elements: data, partnerships and prevention.

First, school attendance data should be tracked and analyzed on a regular basis by district-level teams of educators, epidemiologists and clinicians who can interpret patterns and target solutions. Key questions include: When during the academic year does attendance dip? At what age does it start to falter? Which neighborhoods are most affected? Public health departments can include chronic absence in their community health needs assessments. 

Sharing school attendance data securely with health providers can help identify children with particular conditions, like asthma, who are missing school and require extra attention. In the District of Columbia, for example, pediatricians — with the consent of parents — receive regular reports about which children in their practices are on track to become chronically absent. They then can talk to families about what’s happening. If children are missing school for health reasons, more intensive medical treatment may be needed. If the problem is disengagement in the classroom, clinicians can help assess whether there are additional educational needs. If there are social factors, such as inadequate child care or housing, clinicians can work with social workers in schools or community services to find resources to assist families.

Data alone is not enough; partnerships are essential. Beyond health care providers, community organizations, afterschool programs and religious institutions all have a role to play in supporting families in areas with low attendance rates. Such broad coalitions have a track record of success.

For example, the Cincinnati All Children Thrive Learning Network is a citywide collaborative anchored by the Cincinnati Children’s Hospital and the public school system. The collaboration reviews education and health data and uses it to inform targeted action in the clinic and classroom; for example promoting access to primary care. The results include increased improved third-grade reading scores and reduced pediatric hospitalizations.

The third pillar is prevention. It can be easy to see troubling attendance patterns as simply an issue with a truant student, a problem family or a bad school. But punitive approaches are less likely to work than efforts that listen to parents, address their needs and anticipate future challenges. Using data and evidence to guide action, coalitions can take such steps as providing safer transportation routes to school by improving sidewalk safety, creating protected bike lanes, installing flashing lights on crosswalks and offering better public transportation options; adding services to afterschool programs; and expanding school-based mental health support. Communities can also set a widespread expectation that all kids must go to school every day. Encouraging the development of such norms is difficult, but doing so was at the core of other successful public health strategies, like smoking cessation and traffic safety.  

Not every approach will succeed. To sustain progress, it is important to document, evaluate and share what works and why. Research-practice partnerships such as the Catamount Community Schools Collaborative build long-term collaborations among researchers, health practitioners and representatives from districts and state agencies to quickly assess the implementation and results of innovative programs. In San Francisco, youth are trained as researchers to help in such efforts.

Most fundamentally, this framework’s approach to chronic absence means keeping focus on a measurable outcome and innovating with solutions until every child has the best chance of success, both in and out of the classroom. 

Like heart rate and blood pressure, school attendance is a vital sign for health. Like weight and height, it is fundamental to child development. Now is the time to prioritize reducing chronic absence to support the long-term health of children.

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