By Thalia González, Alexis Etow, and Cesar De La Vega
Education is well-accepted as a key social determinant of health. It serves as a strong predictor of chronic disease, social and economic instability, incarceration, and even life expectancy. For example, by age 25, individuals with a high school degree can expect to live 11 to 15 years longer than those without one. Despite such evidence, education policies and practices have not been public health priorities. Too often, policies and practices in schools that create and compound health inequities are narrated and re-narrated as falling outside health law and policy. This is a missed opportunity for collective action to positively impact the future health pathways of children and communities.
In the wake of national protests against racialized police violence and COVID-19’s disproportionate impact on communities of color, the time has come for the health community — from researchers, to public health organizations, to advocates, to health care professionals — to move from simply affirming that racism is a public health crisis, to actively exposing how structural discrimination in education has fueled disparities and deepened the persistence of health inequities.
Addressing racism in all its forms in education is critically important to ensuring children’s health—the cornerstone of a healthy and just society.
If we are to honor the shared belief that every child should have the opportunity to reach their full potential, public health and racial justice advocates must come together under a broader health justice movement and take decisive action to dismantle structural racism at the intersection of education and public health. As other entries in this symposium discuss, there is a blueprint for such work.
A key starting point is ending the use of punitive, exclusionary, and zero tolerance approaches to school discipline, (e.g., suspensions, expulsions, and referrals to law enforcement), which are sustained by structural, institutional, interpersonal, and intrapersonal racism.
Calls to end racialized school discipline policies and practices are not new.
In 1975, the Children’s Defense Fund found that Black students were suspended at twice the rate of white students not because of any differences in behavior but because of “pervasive school intolerance for children who are different.” In 2018, the Government Accountability Office confirmed that race remained the persistent driver of discipline inequity. Beginning in preschool, Black three-year-olds are 3.6 times as likely to be suspended at least once compared to white preschoolers.
Even the online classrooms that COVID-19 has necessitated are not immune to the racialized nature of exclusionary discipline. In Colorado, a 12-year-old Black student was suspended and referred to law enforcement for playing with a toy gun during a virtual art class. In Michigan, a 15-year-old Black student was incarcerated for violating probation when she did not complete online coursework after her school transitioned to remote learning. Both of these students have attention deficit hyperactivity disorder (ADHD), a fact that affirms longstanding data illustrating the vulnerability and disparate impact of punitive discipline policies on students with intersectional identities.
From a public health perspective, exclusionary school discipline is deeply problematic.
First, it deprives students of a critical social determinant of health: their education. Educational attainment is not only itself linked to better health outcomes, but is also leads to better jobs, higher earnings, safer housing, and increased access to health care services — all of which are necessary for lifelong health.
Second, exclusionary school discipline is a well-documented step in the school-to-prison pipeline; incarceration, in turn, is associated with devastating mental and physical health effects during adolescence and young adulthood.
Finally, punitive discipline practices tear apart crucial protective factors — such as social and emotional connections between peers and teachers — that would otherwise buffer children against the negative effects of trauma and adversity, and instead exacerbates existing trauma. Research shows that children who are pushed out of classrooms exhibit trauma symptoms that look chillingly similar to adverse childhood experiences (or “ACEs”) and post-traumatic stress disorder.
A call to action: fundamental change is needed to disrupt pathways that lead to school health inequities.
We are at an inflection point in our country’s history. No longer can we operate as if racial disparities outside of traditional health care settings, systems, or laws are unique phenomena to be remedied by individual claims grounded in constitutional principles. Instead, we must recognize such outcomes as public health priorities, and craft the legal and policy remedies with not only the civil rights or educational justice issues, but also the public health implications in mind. If we are committed to dismantling structural discrimination and disrupting the pathways that lead to health inequities, then ending exclusionary school discipline policies is a reasonable, and necessary, next step.
Thalia González is a senior scholar in the Center on Poverty and Inequity at Georgetown Law and professor at Occidental College. Alexis Etow is a senior attorney and Cesar De La Vega is a senior policy analyst at ChangeLab Solutions, a national organization whose mission is to create healthier communities for all through equitable laws and policies.