Rural Schools and Health

While primarily focused on education, rural schools also play an important role in the health of students and the community. Working on health-related initiatives makes sense for rural schools as physical and mental health status, physical activity, and good nutrition all impact how students learn. Schools serve as an important community resource and can engage in health-related activities such as:

  • Teaching children about health and wellness topics
  • Providing nutritious meals and snacks
  • Providing opportunities for and education related to physical activity
  • Discouraging and preventing bullying
  • Serving as a location where healthcare is provided
  • Serving as an advocate for children with special health needs
  • Providing counseling and resources related to mental health and emotional well-being

School-based health centers can provide access to healthcare for students who may not otherwise receive care. Rural students may face barriers to accessing healthcare services including long distances to providers, lack of reliable transportation, work demands of students’ parents, poverty, lack of health insurance, and the cost of healthcare. School-based health centers often operate as a partnership between the school and a community health center, hospital, or local health department to improve the health of students, as well as the community as a whole.

Frequently Asked Questions

What role can rural schools play in improving the health of their students?

Schools play a significant role in promoting the health and safety of students. Ideally, rural schools will strive to provide a healthy physical environment for students to learn, provide nutritious meals, and encourage physical activity.

One strategy some rural schools have implemented is the creation of a School Health Advisory Council, which works to promote a healthy and safe school environment for students and staff. This council often has input from students, parents, teachers, and school administrators to identify barriers and solutions to improving the health and well-being of students.

The Centers for Disease Control and Prevention (CDC) uses the term “coordinated school health” to describe school initiatives and policies to promote students’ well-being and health. The model highlights eight aspects:

  • Health education
  • Physical education
  • Health services
  • Nutrition services
  • Counseling, psychological, and social services
  • Staff health promotion
  • Family and community involvement
  • Healthy environment

An expansion of the coordinated school health model from the CDC is the Whole School, Whole Community, Whole Child (WSCC) model, which expands on those eight aspects to improve students’ education and well-being.  For example, there is a work group in Kentucky following this model that has developed health initiatives for the rural Appalachian region.

CATCH (Coordinated Approach To Child Health) is a popular school health program that promotes physical activity and nutritious eating, as well as working to prevent tobacco use among youth. Along with CATCH, SPARK is another research-based school health program that provides resources to schools on physical activity and health promotion programs. For other examples of evidence-based programs schools can implement, see How Can Rural Schools Address Obesity? in RHIhub’s Rural Obesity Prevention Toolkit.

Schools can serve as a location for providing students with counseling and behavioral health services. According to the report, Access to Mental Health Services and Family Impact of Rural Children with Mental Health Problems, 5.8% of rural children are reported to have mental health problems compared to 5.3% of children in urban communities. Schools are the most common location for children to receive mental health services. RHIhub’s Mental Health topic guide has resources on how schools can take action to prevent suicides. For more examples of mental health school-based models, see Models for Schools in RHIhub's Rural Mental Health and Substance Abuse Toolkit.

Oral health is another area where schools can play a role in improving children’s health and helping them develop healthy habits. School-based dental programs can provide dental screenings, fluoride varnishes, dental sealants, and a variety of oral health education to students without them having to leave the school. For examples of what some rural schools have implemented, see the School-based Model section of RHIhub's Rural Oral Health Toolkit.

In addition to school health promotion initiatives and policies, some rural schools are able to employ a school nurse or house a school-based health center, both of which work to directly address the health needs of students. These programs are described in the following question.

What types of healthcare services can be provided in rural schools?

School Nurses

School nurses provide health services in the rural school setting. They work with parents, teachers, and other health professionals to provide a plan for the health needs of the school. School nurses also provide services for students with special health needs such as prescription medications, asthma inhalers, and catheters so that those students can attend school. Nurses in schools provide health promotion activities and education including:

  • Fitness and nutrition education
  • Tobacco use prevention
  • Sexually transmitted disease prevention
  • Teen pregnancy prevention
  • Hearing and vision screenings

In rural schools, nurses often fill multiple roles including clinician, administrator, record keeper, and grant writer.

The 2013 NASN School Nurse Survey: Advancing School Nursing Practice reports on a survey of school nurses in all 50 states. The majority of school nurses who responded to the survey were employed by a public school district and their position was funded by the regular education budget. 30.8% of survey respondents worked in at least one school in a rural area.

The article School Nurse Shortage May Imperil Some Children, RWJF Scholars Warn reports that students in 25% of America’s schools don’t have access to a school nurse, with only 45% having a school nurse available at all times during the school week. The article goes on to state:

“Many rural counties lack even a single physician or nurse practitioner, so the school nurse–if there is one–becomes the ‘frontline expert’ during the school year and sometimes during the summer too…”

School-Based Health Centers

A school-based health center (SBHC) provides a variety of services to improve the overall health of students and their family members, including primary care, immunizations, health screenings, and health education. Some SBHCs provide additional services such as mental health services, vision and hearing examinations, dental services, substance abuse services, and reproductive health services.

According to The Role of the School Nurse and School Based Health Centers from the National Association of School Nurses, having a school-based health center improves students’ access to healthcare services, but the center does not take the place of a school nurse. School nurses are employed by the school district and serve all students. School-based health centers, on the other hand, are usually run by a community health center or hospital, and students must enroll in the clinic to receive services. Collaboration between school nurses and health professionals at the SBHC is important for improving the well-being and education of rural students.

For information about how to start a school-based health center, the HRSA School-Based Health Centers website has information regarding how to apply.

What programs are available to provide children with healthy and affordable meals?

There are several programs available through USDA’s Food and Nutrition Service which provide nutritious meals and snacks to students including:

What are strategies that rural schools can use to increase the nutritional value of foods served to their students?

Rural schools must comply with federal regulations pertaining to school meals. The Healthy, Hunger-Free Kids Act of 2010 was designed to raise the health and nutrition of school meal programs. It is being phased in over a three year period, starting in School Year 2012-2013. As part of the Healthy, Hunger-Free Kids Act, the USDA released federal smart snacks in school standards requiring all food and drinks sold to students at school to meet nutrition standards.

The National Farm to School Network is a movement to bring more local food into schools and to teach children about where their food comes from. The network encourages schools to purchase, prepare and serve locally-grown items. The program also supports bringing students out to local farms to teach children about the importance of nutritious food and local farming. For example, Focus on Agriculture in Rural Maine Schools (FARMS) is a farm-to-school program that connects children, cafeterias, local farms, and communities to promote healthy meals. FARMS started small and worked with stakeholders in the schools including superintendents, principals, and school board members to grow the program.

If school land is available, planting school gardens provides an opportunity for students to be involved in growing different types of fruit and vegetables as well as learning where their food comes from. School gardens are an excellent source of nutritious items for food service staff to prepare for students and school staff members.

For more examples of strategies that rural schools can use to improve healthy food choices, RHIhub compiles rural models and innovations regarding food and hunger.

What are strategies that rural schools can use to increase the amount of physical activity their students get during the school day?

Children need quality physical activity throughout their day to lead healthy lives, to learn, and to prevent obesity. According to the report, Overweight and Physical Inactivity among Rural Children Aged 10-17: A National and State Portrait, many rural children failed to get the recommended level of daily physical activity. Key facts include the following:

  • Rural children get slightly more daily physical activity than urban children.
  • 25% of rural children failed to meet the recommended amount of physical activity compared with 29% of urban children.
  • Almost 41% of children living in rural areas did not join an afterschool sport.
  • 48% of rural children ages 10-17 spend at least two hours per day using electronic devices, such as watching television or playing video games.

There are several model programs that address physical activity in rural schools. According to School-based Programs Help Children Shape Up, rural schools are incorporating physical activity into their school curriculums to reduce childhood obesity. For example, school children participated in Shape Up Across Oregon, which encourages physical activity as the students take a pretend journey across the state of Oregon and track their activity as miles on a map.

Brain breaks are short activities in the classroom, and they are a great way for schools to add small amounts of physical activity to the school day without schools feeling like they are losing valuable educational time with students.

What health education and prevention programs can be implemented in a rural school to improve students’ knowledge of how to maintain their own health?

There are many health education programs that rural schools can implement to improve students’ knowledge of how to maintain their own health. For example, in the state of California, they have implemented School Health Connections, which seeks to integrate student academic success with student health. The program addresses health education, physical education, health and nutrition services, a healthy school environment, family involvement, counseling, and social services. Through wellness education and activities in school, students learn the importance of adequate sleep, nutrition, physical activity, stress reduction, and skills to improve their relationships with other students, family members, and friends.

In South Dakota, the Harvest of the Month Program encourages schoolchildren to make healthy eating choices by tasting different fruits and vegetables. Students in the program can sample new foods and are encouraged to make healthy food choices at school and at home. Exposing young children to a variety of nutritious foods in a positive setting will help them improve life-long healthy food behaviors. This Harvest of the Month program is based on a model from Network for a Healthy California and has been implemented in other states as well.

Two popular health education programs are CATCH and SPARK, which teach health promotion activities during the school day as well as encourage positive behaviors outside of school.

It is important for rural schools, teachers, and coaches to take an active role in preventing injuries during gym classes, school practices and during school sporting events. Teachers and coaches can educate student athletes and parents about the dangers of head injuries and can teach and promote safe playing techniques. More information is available from the Centers for Disease Control and Prevention regarding preventing traumatic brain injury while playing sports and monitoring the health of student athletes who have symptoms of a concussion.

According to the article, Rural Schools, Medical Facilities Partner for Athletic Training Services, some rural schools in Montana and Ohio are receiving free athletic training services from hospital staff. In exchange, the hospital receives exclusive marketing and sponsorship rights to the school’s sporting events including signage on the school playing fields, posters inside the school and advertisements in game programs. Since many rural schools do not have an athletic trainer, this is an opportunity for injured student athletes to be examined and given instructions on exercises for rehabilitation.

How can schools promote population health within their communities?

Population health is defined as the health outcomes of a group of individuals, such as the residents of a specific rural community. Schools can promote population health by providing health promotion and disease prevention education to their students, staff, parents and other family members. The prevention of obesity and diabetes can have an impact on the whole community’s health and vitality.

Schools can also partner with health departments, businesses, and community groups to support physical activity programs by allowing community members to use school gymnasiums and playgrounds when school is not in session. In small, rural communities where funding for gymnasiums, exercise equipment, and playground equipment is limited, it is important for community organizations to work together to provide opportunities for physical activity.

Rural schools can motivate staff, students and community members to increase physical activity by creating walking clubs, running clubs, or other opportunities for group exercise.

Rural schools could also provide health fairs and wellness days for staff and students to gain awareness of health issues and inspire individuals to take an active role in their healthcare.

Some rural communities are losing their local school through school consolidations due to decreasing student enrollment. Schools are important to their community viability and community health status because schools also serve as social and cultural centers for sports, theater, music and other wellness activities. According to the report, The Role of Education: Promoting the Economic and Social Vitality of Rural America, the capacity of a community to maintain a local school is a strong indicator of a community’s well-being. 

Breaking the Fall: Cushioning the Impact of Rural Declining Enrollment reports that when rural schools close, students have longer commutes to other schools, which has been linked to declines in parental involvement, a decrease in student participation in extra-curricular activities, and a decline in the connection between the local school and its community. Parental involvement in school and student participation in extra-curricular activities can improve health outcomes, so these are important concerns for rural schools facing consolidation.

How are schools addressing the shortage of health professionals and getting students interested in health careers?

In looking at the health of the community long-term, many rural schools realize the need to expose students to healthcare careers, in hopes of “growing their own” healthcare providers that can care for the community’s citizens down the road.  To do this, many schools partner with Area Health Education Centers (AHECs) which provide health career education programs for students.

AHEC initiatives address healthcare workforce issues by exposing students to career opportunities. AHECs also help host career fairs for schools to display the variety of careers within the healthcare industry. For example, the West Virginia AHEC is involved in health workforce pipeline programs including:

  • High school health career clubs that meet monthly.
  • Shadowing opportunities for high school students at Federally Qualified Health Centers and their affiliated school-based health centers.
  • Health career fairs that target middle and high schools or Health Occupations Students of America (HOSA) clubs.
  • Opportunities for students to learn about medical procedures using robotic simulators.
  • Assistance to students preparing for college admission tests, including the Medical College Admission Test (MCAT).

In the May 2012 issue of Health Workforce News, Sandra Pope, Director of the West Virginia Area Health Education Center, shares more about her work partnering with schools on health workforce initiatives.

What funding programs are available to support school-based health services?

The Health Resources and Services Administration (HRSA) awarded almost $200 million from 2010 through 2013 for school-based health centers. These grants have supported many rural schools in their ability to provide school-based health services.

The Federal Office of Rural Health Policy offers the Rural Health Care Services Outreach grant program. This program supports projects that demonstrate effective models of outreach and service delivery in rural communities. Funding can be used to address school-based health services including health promotion and disease prevention activities.

According to the report Improving Rural Health: State Policy Options, funding for school health centers varies greatly from state to state, with many schools relying on a mix of public, private, and non-profit funding. States can direct funds to school-based health centers from various sources including the general fund, taxes, and the federal Maternal and Child Health Block Grant.

Other funding programs for school-based health may be found on RHIhub’s list of funding opportunities related to schools, which includes federal, state, and private foundation funding opportunities.