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Welcome to PSR's Environmental Health Policy Institute, where we ask questions -- then we ask the experts to answer them. Join us as physicians, health professionals, and environmental health experts share their ideas, inspiration, and analysis about toxic chemicals and environmental health policy.

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School Children: The Forgotten Issue -- Preventing Exposures Boosts Achievement

By Claire Barnett

Unhealthy schools are a threat to public health and an injustice to children.

Ninety-eight percent of all school-aged children attend school. Other than home, schools are the environment where children spend the most time. Yet tens of thousands of P-12 school buildings are dirty, polluted, or decayed. Many are sited on or too close to hazards. As a result, school environments leave the most vulnerable learners at risk of or with suspected exposures that no agency addresses.  

The science is clear: physical environmental stressors in schools measurably affect children’s achievement. A breakthrough came in 2006, when the National Research Council found sufficient evidence linking environmental factors and children’s (and personnel’s) health.[1] In 2011, the Institute of Medicine found that “[p]oor indoor environmental quality is creating health problems today and impairs the ability of occupants to work and learn” and recommended “preventing exposures” (which it said can be 100-1,000 times more intense indoors than out).[2] Indoor exposures include poor ventilation, indicated by high CO2 levels indoors, and an indicator of the build-up of pollutants such as VOCs that can lead to health problems for children and adults,[3] as well as environmental hazards leading to an increase in chronic, non-communicable diseases.[4]

Both reports also found that conventional green buildings (or schools)—focused on energy and resource conservation—offer no assurances of health or learning benefits. Instead, improving occupant health requires designing in attributes that improve indoor environmental quality—dry, clean, quiet, easy to clean, good indoor air quality. The reports document the benefits of healthy indoor environments in schools to children’s health, behavior, and achievement. What’s more, contrary to popular belief, healthy schools also deliver major cost savings and other benefits by reducing health and education costs.

Vulnerable children, unhealthy schools

Children are biologically more vulnerable than adults. They are more exposed to hazards, but less able to identify them or remove themselves from harm’s way. Teachers and other adults in school buildings have some recourse for suspected exposures, via their unions, contracts, or occupational public health services. Children, who outnumber adults in schools by more than 8 to 1, have no equivalent. No federal or state agencies provide oversight or services to children at risk of or with suspected exposures at school.[5],[6]  

Nor is there surveillance or baseline data on children’s health in school that would permit public health agencies to evaluate outbreaks and design a research and prevention agenda. In fact, one of the few published reports looking at school environments’ effects on children took place back in 1984. The National Institute for  Occupational Safety and Health evaluated school personnel health; a companion survey of parents reported that more children in the same school had health symptoms (headaches, coughs, itchy eyes, sore throats, runny noses) than the adults occupying the same buildings. Note, NIOSH is authorized to address worker health, not children’s health.[7]

Healthy Schools Network’s Towards Healthy Schools 2015,[8]released with leaders of the national Coalition for Healthier Schools, presents data and policy profiles on each state. It reaches a stark conclusion:

“ALL public and private school children are at elevated risks of health and learning difficulties due solely to the unexamined and or unaddressed environmental health and safety risks in their schools and the lack of public health services for children at risk or with suspected exposures.” 

Prevention pays: reduced illnesses, reduced costs

In 2008 and 2011, studies showed schools filled with asthma triggers[9] and also found that pediatric asthma hospitalizations in New York can rise 300% on returns to schools throughout the year.[10] Another study shows that healthy indoor environments improve children’s health and learning, calculating that schools can reduce asthma episodes by almost 40% and upper respiratory infections nearly 70% by adopting proven best practices.[11]

A healthy learning environment for every child is a is a moral imperative. But it’s prevention’s economic benefit that is beginning to attract attention. The savings would be considerable. According to a 2008 estimate, “diseases of environmental origin in children cost $76.6 billion annually.”[12] This includes costs for asthma, intellectual disabilities, and other health conditions that can be exacerbated by exposures in the school environment.

A more recent study compared the costs of various health care strategies, finding that prevention pays off in the long run. In fact, health protection in the form of healthier behaviors and environments is more cost effective over the long term than health care coverage and access to medical care.[13] Another estimate finds that a new, average-sized healthy school can reduce asthma incidence 25%, which translates to 20 fewer children a year with asthma and a savings of $33,000.[14]

Very simply, given the costs of disease—to children, families, education, and the overall health care system—federal and state agencies should define, institute, fund, evaluate, and report on an array of preventive public health services for children in schools and child care centers at risk of or with suspected exposures.

Some progress, but steps backwards

Despite all the grim facts, environmental health at school is at last drawing attention at the federal level, although more budget cuts loom. EPA has issued first-ever federal guidelines on school siting and on ways state agencies can address environmental health at school. Its Green and Healthy Schools Initiative has just awarded grants to agencies in Connecticut, Minnesota, New York, Ohio, and Wisconsin. [15] These welcome developments have been undermined, unfortunately, by several missteps, particularly EPA’s failure to address how state agencies might engage pediatric environmental health experts on school exposures, as mandated by Congress.

The US Department of Education has become active on school environments. While its award criteria undervalues decades of work by EPA and CDC, the new Green Ribbon Schools Award is stimulating state education agencies to attend to multiple issues they have too often ignored.  

Meanwhile, at CDC the outlook is less hopeful: it has dismantled its division of school health and cut its lead and asthma program funding.

Moving forward: improving environmental health at school

How do we improve school environmental health and keep our children safe, healthy, and ready to learn?

Short-term: ask your school to reduce hazardous chemicals stored or in use on site, and to check classroom CO2 levels before high-stakes testing takes place.

Longer term, three reforms hold the best potential:

  • A permanent federal interagency council with an appointed federal advisory committee is needed to address children’s environmental health and the environmental conditions and practices of PK-12 schools on an ongoing basis. There is no other way to ensure that agencies collaborate and sustain a coordinated message to the states and local schools.    
  • Federal and state initiatives should fund and implement environmental public health clinical and other services for children’s environmental health in schools and authorize state health agencies to intervene to prevent harm to children.  
  • Federal agencies should develop a research, tracking, and surveillance agenda for environmental health in schools.

School children don’t vote and don’t have a PAC. As New York’s Governor Cuomo has remarked, they “have no lobbyist.”  We urge PSR to join us in taking up the challenge: advocating for a system of preventive public health that makes school environments healthier for children.



[1] National Academies of Science, National Research Council, Green Schools: Attributes for Health and Learning, 2006.

[3] John D. Spengler, “Climate change, indoor environments, and health,” Indoor Air 22:2 (April 2012): 89–95.

[6] Jerome Paulson and Claire Barnett, “Who’s In Charge of Children’s Environmental Health at School?,” New solutions: a journal of environmental and occupational health policy,20:1(2010): 3-23.

[7] National Institute for Occupational Safety and Health (R. Gorman and M Singal), NIOSH Health Hazard Evaluation Report: Wappingers Central School District, Wappingers Falls, New York. Cincinnati, OH, HETA 83-172-1409, 1984.

[8] Coalition for Healthier Schools, Towards Healthy Schools 2015, 2012.

[9] New York State Department of Health, Asthma and the School Environment in New York State, 2008.

[10] Shao Lin, Rena Jones, Xiu Liu, and Syni-An Hwang, “Impact of the return to school on childhood asthma burden in New York State,” International Journal of Occupational and Environmental Health 17: 1; January 2011.

[11] Gregory Kats, "Greening America’s Schools: Costs and Benefits," October 2006, p. 15.

[12] L Trasande and Y Liu “Reducing the Staggering Costs of Environmental Disease in Children, Estimated at $76.6 Billion in 2008,”.Health Affairs 30:5 (May 2011): 863 – 870.

[13] B Milstein et al, “Why Behavioral and Environmental Interventions are Needed to Improve Health at a Lower Cost,” Health Affairs 30:5 (May 2011): 823-832.                                         

[14] Kats, p. 15.

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