UF Researchers: School-Based Clinics Step Toward Health-Care Reform

February 19, 2003

GAINESVILLE, Fla. — Despite becoming a political battleground over conflicting moral values, school-based health centers have thrived and even been touted as an innovative health-care reform, say two University of Florida authors of a newly published book on the subject.

Such clinics – which offer everything from physical exams and immunizations to reproductive and mental-health services – grew sevenfold from 200 in the United States in 1990 to 1,400 in 2000, said Barbara Rienzo, a UF health education professor and co-author of “The Politics of Youth, Sex and Health Care in American Schools.”

“School-based clinics have gained increased acceptance because of the unique role they play,” said Rienzo, who co-wrote the book with UF political scientist James Button. “In fact, some people call them a partial answer to America’s health-care crisis because they begin to address the huge issue of the uninsured.”

Nearly 11 million children in the United States – one in six – lack medical insurance, Button said. Children and adolescents without health insurance have high poverty rates and are vulnerable to numerous health risks, including HIV and AIDS, he said.

Health clinics based in elementary and secondary schools have educational as well as health benefits, even getting credit for keeping students in school. One study found that teenagers who use them are nearly twice as likely to graduate from high school as those who don’t, he said.

The majority of school-based health centers serve poor children in inner cities, but their biggest growth has occurred in suburban areas in traditionally more-conservative states in the Sunbelt and Midwest, according to the UF professors, who began their research 12 years ago.

“Middle-income parents see the advantage of having all these services provided at school,” Rienzo said. “Mom and dad don’t have to leave their jobs to take their youngster to the doctor. Businesses are supportive since their employees’ absenteeism is decreased, and parents feel more secure when they know their children are safe.”

The book’s research is based on a random survey of 350 clinics, along with in-depth site studies in Albuquerque, N.M.; Jersey City, N. J.; Portland, Ore.; Quincy, Fla.; and Virginia Beach, Va.

“In every one of the clinics in the five cities we visited, we saw less resistance from religious and other groups than we did in the early ’90s,” Button said. “I think parents realized these clinics provided services that poor kids in particular really needed.”

Spearheaded by religious conservatives whose tactics include busing out-of-town protesters to school board meetings, opposition has focused on the reproductive health services that some of these centers provide, Button said. Calling them “sex clinics,” adversaries charge that these facilities encourage teenage sexual behavior and abortion.

As a result, the most controversial of these services – birth control dispensation and family planning counseling – were limited or not provided at all, leaving about 25 percent of the nation’s clinics to offer them, Button said

Despite such opposition, statistics show less resistance to these clinics than when they first started, the researchers said. The 2001 census of school-based health centers reported that of 36 states asking for start-up information, those in only 13 indicated that opponents had contacted them, she said.

In addition, state funding of these clinics increased dramatically, from $17 million in 1992 to $61.9 million in 2000, although lack of state money is now a major problem with the downturn in the economy, Button said.

“Certainly the prosperity of the ’90s has disappeared and poverty rates and the number of uninsured is going up, conditions that make these clinics more important than ever,” he said.

Clinics are most likely to survive and even flourish in tough economic times when supported by a broad-based political coalition of parents, students, the media, business leaders and education groups, Button said. Parental involvement is especially crucial, and successful clinics make sure to have parents on their advisory boards, he said.

“More connections with religious organizations, foundations, local businesses and universities should be developed,” Button said. “President Bush’s recent emphasis on increased federal funding for faith-based organizations may provide the incentive necessary to seek this kind of support.”

Joy G. Dryfoos, a child advocate and author of the book “Safe Passage: Making It Through Adolescence in a Risky Society,” said Button and Rienzo’s research book is candid in its portrayal of the problems facing school-based health centers and practical in suggesting solutions. “Their unique review of the opposition shows how sexuality issues are used to try to turn the public against these clinics and how advocates can overcome such attacks,” she said.