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Where Are Our Graduate Schools of 'Educational Public Health'?

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This blog is co-authored by Eric Colburn, an English teacher at Brookline High School. Colburn blogs at Literacy in Leafstrewn.

Mark Twain famously said that he never let schooling interfere with his education. An exaggeration, no doubt, but it gets at an important reality. A lot of one's education -- arguably, most of it -- happens outside of school. Arizona State University education expert David Berliner, for example, estimates that 60 percent of educational achievement is driven by out-of-school factors, with in-school factors contributing only 20 percent, at most. Though teachers can't help but address this reality every day, most current policy discussion ignores it, to our collective detriment.

Perhaps our discussion about education is so limited and inadequate in part because we simply lack the right terms with which to have it. If so, drawing on the field of public health, and lessons derived from it, might help. Is a person's health status due largely to factors that have little to do with doctors or treatment? Yes! So, a closer look at parallel issues in medicine and health might improve our understanding of the school/education distinction.

Unlike education, health has a very clearly defined field, distinct from "medicine," that assesses larger social factors. That field has its own prestigious schools that parallel medical schools, professors, and a vast body of research. It also has a handy name: "public health."

The distinction between medicine and public health is an important one. To think in terms of medicine is to think about directly "treating" the individual "patient." To think in terms of public health is to explore factors directly or indirectly affecting larger populations. A public health perspective sees cancer not so much as an individual patient's illness, to be treated with knives and poisons, but rather the result of societal factors including pollution, poor diet, or abuse of alcohol or tobacco. Broadly speaking, public health tries to prevent problems, while medicine focuses on treating them.

Both of these perspectives are useful and necessary, but the public health perspective is arguably far more important. Just as out-of-school factors contribute far more to educational achievement than do in-school factors, public health factors contribute far more to health than medical factors. Surprising, but true. According to a CDC report, "During the 20th century, the average lifespan in the United States increased by more than 30 years, of which 25 years can be attributed to advances in public health."

We don't, unfortunately, make the same distinction in education. When the Gates Foundation attempts to "advance student achievement," or when presidential candidates or the New York Times assert that improving educational achievement is critical to strengthening the economy, the focus is entirely on schools, with barely a nod to the "public health" aspect. At best, we get the oft-repeated truism that the teacher is "the most important in-school factor in student achievement" -- a sneaky formulation that masks the far greater impact of out-of-school factors.

But perhaps a new term isn't sufficient. Even public health, with its well-known name, is underestimated, underfunded, and often ignored. There are structural reasons for focusing, instead, on the medicine side.

What would be best for the public as a whole may conflict with personal (or business) interest, as was true of banning tobacco in bars. Often, too, special interests will lose much more, per person, than the public interest will gain. Clean air regulations are one example: adding a year to everyone's life is a good thing, but that year is, at the individual level, uncertain and far away, while affected industries may lose millions of dollars in profits today. So public health initiatives face an uphill battle.

Policies and funding supporting the medical approach face far fewer structural barriers. The most highly energized advocacy groups are comprised of people directly affected by disease, who tend, naturally, to prioritize treatment and cure over prevention. If you or someone you love has breast cancer, you are most concerned with getting rid of it, not with decreasing the chances that others will get it in the future. Doctors, too, have more incentives to focus on treatment than on prevention; there's more glory in it, there's more money in it, and there's probably more immediate human satisfaction in treating a suffering patient than there is in helping a healthy person stay well.

The same structural factors are at work in education. Although in-school factors account for a minority of educational achievement, students, parents, teachers, and even those with no children but property values at stake, are motivated to improve their own local schools. Educational public health, on the other hand, has no particular constituency.

Maybe what we need, then, are incentives to build that constituency, to bring together advocates for schools, early childhood programs, health, nutrition, extracurricular enrichment, and the many other drivers of educational attainment. The Broader Bolder Approach to Education represents one such constituency. Join us in calling for a more comprehensive -- public health -- approach to education!