School-Based Healthcare and Academic Performance: Implications of Physical Health Services for Educational Outcomes and Inequality

Health and education are reciprocally related, and research indicates that unhealthy students are poorly positioned to learn. Providing services that prevent health problems or help students cope with existing health concerns is one way that schools intervene in the relationship between student background and educational outcomes. Providing health services on campus is theorized to promote educational goals by increasing access to services, improving health, and enhancing opportunities to learn. However, existing empirical tests of this relationship are rare and have important limitations. This paper uses data from Add Health, which identifies numerous services provided by schools across the U.S. Multilevel models test how availability of preventive or physical health services relates to adolescents’ academic performance as well as implications for racial and socioeconomic educational inequality. Analyses consistently demonstrate that school provision of preventive/physical health services is positively related to youths’ educational outcomes—including a higher GPA, lower odds of failing courses, and higher odds of graduating from high school—but also little evidence of differing associations across student subgroups. Additional results mitigate concerns that these relationships are biased by selection and offer evidence that increased opportunities to learn are one mechanism for the positive role of health services.