The Obama administration focus on federal USDA policies including school wellness policies, coupled with Let’s Move, Alliance for a Healthier Generation, and other national nonprofit promotion of more child physical activity and healthier nutrition, helped grow awareness of child obesity and its root causes. These efforts laid key groundwork for large-scale change.

However, school-based change in the USA is basically controlled and funded at the state and local levels. In addition, when it comes to deeply ingrained social & health habits, reinforced by powerful economic interests and institutional status quo inertia, there is a limit to what centralized top-down change can accomplish on its own. We need to think nationally but act locally, think big-picture but act grass roots—improving systems and empowering individuals to develop healthier lifelong habits.

However, there has been at least one bright spot: the campaign to reduce smoking. The highly successful, multi-decade fight to reduce smoking through a broad range of strong public policies has been inspiring. The antismoking movement has demonstrated the potential to reverse very unhealthy habits among almost 30% of all adults–even though those habits were anchored in the physical addiction of nicotine. Cigarette smoking was reduced from 42% of adults in the 1960s to less than 14% today—and is still decreasing! But we are not utilizing any of these proven public health strategies to increase physical activity and improve healthy nutrition:

Education, Medication, Incarceration

It is said that all state budgets consist primarily of “education, medication and incarceration”. There is a long-term trend toward states spending more on “medication” and less on “education”, as health costs go up—and the population becomes unhealthier and lower-income.

How do we prevent the on-going shift—away from funding education for a better future, toward publicly subsidizing chronic conditions caused by many years of unhealthy habits? What can we do, for example, as fully 5% of the Arizona state budget shifted from education to health during a recent 15 year period—and as this trend worsens with the state’s shifting demographics?

The potential collateral damage to state budgets is terrifying. As inactivity and unhealthy nutrition drive obesity, diabetes, heart disease, preventable cancer, etc. ever-higher:

How will we have enough money available in the future to adequately fund education, when we are already struggling to meet basic K-12 spending needs—when health costs are already overwhelming government and family budgets?

Fortunately, the evidence shows that we can kill two birds with one stone:  we can help increase funding for schools, and reduce health spending, at the same time. Making people healthier early in life through preventive K-12 education reallocates monies away from “disease management”—in order to invest more in education.  We achieve this, by investing health money into K-12 schools: re-focusing the state & nation on quality effective physical and nutrition/health education, healthier nutrition, and physical activity at school.

A-F School Accountability

As part of our strategy, we are developing state support for effective, quality physical and health education. The state A-F school accountability formula and future whole child school report card are essential parts of this.

We are working with our Healthy Future Arizona coalition to lead essential changes in the Arizona A-F system for all 1.1 million public school students—creating incentives for schools to restore quality physical & health education.

Thanks to our efforts, following State Board of Education approval in May 2017, Arizona will now be one of the first states to add physical, health & arts education indicators to the state A-F school grading accountability formula, by which each public school is graded A, B, C, D or F.

Working with AzHPE (Arizona Health & Physical Education professional educators’ association) and others, we are proposing a practical, low cost, school-friendly, valid & reliable approach to add physical and health education indicators to the state’s A-F accountability formula. Our proposal provides an evidence-based, intended, “good incentive”—for the majority of schools, which have cut PE to 1-2 days/week or less. Per their own testimony, they will be much more likely to invest more time in moderate-to-vigorous physical activity and developing lifelong healthy habits among all students.

Schools do not need to spend more to do this—just restore time which was taken away over the past 20-30 years back to PE, health ed, recess and the arts. A mountain of evidence shows that slashing these “specials” and recess did not improve student achievement in reading, writing, and math—but it did harm children’s health, social-emotional development, and creativity.

Schools can improve student health, academic achievement and student engagement, synergistically, as the evidence shows. As noted in a range of peer-reviewed journal article studies:

  • “Given competent providers, [up to 60 minutes] PA [physical activity] can be added to the school curriculum by taking time from other subjects without risk of hindering student academic achievement. On the other hand, adding time to ‘academic’ or ‘curricular’ subjects by taking time from physical education programs does not enhance grades in these subjects and may be detrimental to health.” Trudeau & Shephard, 2008
  • “…changing time spent in recess and PE is unlikely to affect student test scores.” Dills, Morgan & Rotthoff, 2011
  • “There was no documentation of APA [aerobic physical activity) having any negative impact on children’s cognition and psychosocial health, even in cases where school curriculum time was reassigned from classroom teaching to aerobic physical activity.” Lees & Hopkins, 2013 (systematic review of RCT [Randomized Control Trial] studies)

Schools which implement the Plan-Develop-Assess model with fidelity should in the future be able to maximize their physical & health education-related A-F points, to help improve their school’s A-F grade, while not harming academic achievement.

School Recess Laws

Recess is a long-neglected, no-cost way to increase student physical activity, overall health, and engagement in school.

We co-led Arizona’s adoption of a national breakthrough recess law in 2018, together with Arizonans for Recess & School Wellness, Arizona Health & Physical Education, Arizona Public Health Association, Arizona Education Association & many others. This law is increasing physical activity by 50% for 250,000 K-5 students in Arizona.

It is absurd, yet a sad fact, that most elementary and middle school students have only one brief recess in a 6-7 hour school day. And many of those same students only have PE for 30-45 minutes each week…if that.

There is a multidisciplinary consensus, grounded in research evidence, that regular recess breaks optimize cognitive, physical, social, and emotional child development; enhance attention, memory, and classroom behavior; and improve student attendance and achievement.

Requiring daily recess periods ensures child access to school-day play breaks, which are proven to foster communication, cooperation, creativity, and problem-solving. These key life skills are not only foundations for healthy child development, but predictive of future success in life.

The American Academy of Pediatrics and the CDC call recess a critical part of the school day.

In Arizona and other states, recess is often withheld to punish classroom behavior or for academic work, despite the SHAPE America and Arizona Department of Education’s professional standard against withholding recess, and concurring Arizona School Boards Association (ASBA) model policy. Instead of increasing classroom discipline, these counterproductive practices make students antsier and less focused—and even more likely to become defined as “bad kids”—even though all that many of them need is more frequent exercise! We are working with our coalition partners to end these malpractices.

60 Minutes Daily Physical Activity for Health

In a definitive 462-page report published in 2012, the Institute of Medicine of the National Academy of Sciences concluded that children generally need at least 60 minutes of moderate-to-vigorous physical activity daily to be healthy. Yet schools are often providing only 15-20 minutes per day—followed by hours of “screen-time” sitting at home.

Here is a proven example of how we CAN get to 60 minutes at school, even with less than ideal PE and recess time:

For example, Arizona requires 712 annual instructional hours for grades 1-3 (about 4 hours daily) and 890 annual instructional hours for grades 4-5 (about 5 hours daily).  The school day is typically 6-7 hours long.  Schools still offering 2-3 daily recesses prove there is time in the existing school day for more than just lunch recess, so that children are able to recharge between lessons and approach the needed 60 daily minutes of physical activity.  Per the Arizona Department of Education, “schools are the only setting where all students can engage in physical activity during the day, making them a critical environment for providing and promoting physical activity.”

Please visit our partner Arizonans for Recess & School Wellness for much more information on recess.

Whole Child School Report Card

We need comprehensive, recent data on school health-related policies & practices. This provides objective accountability for enforcement of the recess law, for the A-F school accountability system, and for new policy advocacy and financing. The better the data, the more compelling the policy becomes.

For example, the fact that recess & PE have been slashed by more than 50% in most schools helped us convince >90% of legislators to vote Yes for SB1083—even though we had to piece some of that data together from an ADE survey conducted in 2010.

In addition, given the level of school choice in many parts of Arizona, educating parents on whole-child non-standardized-testing aspects of schools helps families select schools that are better for their children, in the broadest sense—and not just strong academically. (And the research shows: health & cognition are mutually beneficial.)

K-12 Prevention Fund

We are talking to the health and business sectors about investing in a statewide private-public “K-12 Prevention Fund”. This will be a dedicated statewide fund, financed with a small percentage of health spending–with shared governance, high transparency & accountability, proven strategies, & aggressive cost-saving goals.

We call this “Prevent%”, since the vision is for all organizations, which pay a substantial portion of their budget for health costs, to start allocating a certain percentage of their health spending to effective prevention–starting in K-12 schools.

This is true social impact investing, with funders only paying for results–unlike typical public funding or community-relations/charitable-giving by health organizations. This creates a much higher comfort level among private & public investors.

We achieve this via a Healthy Future Arizona intermediary with shared cross-sector governance. So foundations, legislatures, health organizations and employers do not need to get involved directly with schools. But they can hold the K-12 Prevention Fund accountable for improving health—including only investing monies in the Fund based on objectively measured performance in improving health and lowering medical costs. Please stay tuned—more details to follow.

More Information on Policy

Please see our latest slide deck for more details.