An Ugly Truth: The Dangerous Correlation Between Poverty, Health and Education

March 4, 2016 | Tiffany High

As a key social determinant of health, education is something that has the power to shape the course of a life. We have previously explored the negative effects of toxic stress, including impaired memory and decision making ability, and behavioral issues—which can impact the ability to receive a quality education.

Children born into stressful households and living under conditions where they are exposed to chronic toxic stress will begin their educational careers at a disadvantage. Repeated exposure to stress hormones eventually reduce the threshold for their activation. In short, their brains are perpetually in “fight or flight” mode.
Education is key to success social determinants
“Fight or flight” refers to the natural instinct and chemical response that prepares our bodies to either combat or flee a perceived threat. While useful when faced with real danger, this can be a huge liability for a student. A common analogy compares it to attempting to solve a math problem while being chased by a bear. The ability to identify, reason, and retain important information is greatly diminished.

Achievement gap, or resource gap?

So what happens when the learning environment itself is a source of stress? There have been clear disparities in the academic performance of students nationwide, however, broad references to a “Black/White achievement gap” are misleading and troublesome. Students fortunate enough to evade toxic stress in their homes may have a different round of stress to contend with when they arrive at school, especially if they happen to live in economically challenged districts. These districts are more likely to suffer from years of neglect, and lack of resources and opportunity.

For example, the State of Michigan has another crisis on its hands (in addition to the Flint water crisis). The crumbling infrastructure of Detroit Public Schools has become part of a national conversation as conditions have grown so deplorable that teachers staged a number of “sick outs” in late 2015 and early 2016. Everything from leaking roofs and the resulting water damage to ceilings, walls and floors, broken windows, mildew, mold, cockroach and rodent infestations have taken their toll on teachers and students, disrupting the educational process. This is the epitome of a stressful learning environment. How can a student be expected to concentrate during an exam with rats running across the room? A suburban student wouldn’t have these concerns. How can you compare the academic achievements of students who exist in separate realities, facing different challenges?

Socio-economic status is the great divider, not race or genetics.

This theory is actualized in Harlem Children’s Zone (HCZ) schools, located in a statistically low-income area of New York City. By all accounts, these students should be suffering the same fate as others who live in economically depressed areas across the country—showing poor academic performance—if not for the intervention of HCZ. They take a holistic approach to education. By working to improve the communities and living environments of children in poverty, through parental support, health and social services, their minds are free to focus on their education. Administrators also maintain high academic standards…that are consistently met! HCZ students had a 93% college acceptance rate across all their programs in 2015. To put that in perspective, in 2013 the immediate college acceptance rate (right after high school) was just 66% nationally. HCZ graduates even surpassed graduates from high income families, who had an 80% college acceptance rate in 2013.

Kids don’t need to be exceptional to excel in school if they are actually given the opportunity to learn. Clearly, more needs to be done to create those opportunities. Although it is their goal to have their model replicated nationwide and perhaps even worldwide, schools like those within Harlem Children’s Zone are unfortunately a rare exception. Consequently, their program is highly competitive with admission granted by lottery.

Low expectation leads to low performance

The lower standards held for school buildings themselves are often correlated with the lowered expectations some educators have of their student populations. The Center for American Progress published a report in 2014 called, “The Power of the Pygmalion Effect” which refers to the idea that people do better when more is expected of them. Their study found that high school students whose teachers had higher expectations of them were more likely to graduate from college. Teachers generally have lower expectations for students of color and those from disadvantaged backgrounds. College prep courses and other educational opportunities that present themselves when an educator has higher expectations are key predictors of college graduation rates.



I really think you have something there as far as growing up in a economicly disadvantaged status. Because of the history of our country, there is no question that blacks in particular have experienced this. However I diagree with the notion that blacks are treated so differently for no reason. The black culture is far different from what most others experience growing up. Because of their history within American society. This is often the cuase of bad behavior, and is often overlooked in these conversations. Its a generational curse that keeps perpetually occurring over and over. The key is really family values and cultural change in more positive and healthy ways. I think most understand this, but are continually side tracked by race baiters. It is also hard to change the mind set of people who by experience have lived out a disadvantaged life in many ways themselves to teach there children a different way. The problems are obvious, the solutions are harder to come by and varied based on individual situations. The government can not fix this the answers will come from families and the culture itself has to be changed. The recial card helps no one and actually stops the positive conversation to move forward and begin to heal our people and our nation. Respectfully submitted for your consideration.

Focus For Health Team

Thank you for your comments. We appreciate open and honest feedback from our readers. It seems we agree on a lot of issues.

Our article addresses economic inequalities in our country and how it subsequently affects our children’s ability to receive a quality education. Unfortunately, these inequalities disproportionately affect the Black community. Racial differences in school discipline are well-documented with studies from respected institutions. Here is one example:

Our country will never be able to address its problems if we don’t take a good honest look at the causes. It is true that family is the key to stability in ALL communities, not just Black. But we can’t ignore policies and practices that created the instability for these families. This is a multi-faceted problem that will require a multi-faceted solution.

Dennis Walto

Dear Focus for Health Team – First, thank you for publishing this thoughtful and spot on article about the linkage between poverty, health and education. At Children’s Health Fund, we could be a stronger advocate of your position.

It is well known and documented that education is a critical pathway by which children can break the cycle of poverty. However, many of these same kids struggle with multiple health issues, including vision and hearing problems, dental pain, uncontrolled asthma, behavioral health issues, hunger and social stressors, that interfere with their attendance, behavior and engagement in school. At Children’s Health Fund, we call these health barriers to learning and we are doing something about them…

CHF goes beyond merely identifying health barriers to learning, we aim to connect with, train, and empower parents, teachers and health care providers—all stakeholders involved in a child’s school-health life—to produce the outcomes that matter most to at-risk children: improved management of health-related barriers to learning, improved attendance, fewer behavioral incidents that interfere with learning, and ultimately improved academic performance. These activities are accomplished with close collaboration and coordination with other service providers both in the school and in the surrounding neighborhoods.

The NYC Healthy and Ready to Learn (HRL) program began in September 2014 in 3 NYC public schools. The first 3-5 years of the program is being considered a demonstration/pilot phase, where the HRL team is assessing multiple aspects of the program, including how it’s working, what it’s doing, and who it’s serving. This initial phase will look closely at whether all elements of the HRL model can be implemented with the human and financial resources available, and the team is continuously reviewing processes and outcomes and identifying changes that increase effectiveness, save time and save money.

What makes HRL is unique is that it targets multiple health barriers to learning at the school, family and individual student levels. Each of three NYC demonstration schools, P.S. 36 in Harlem and P.S. 49 and P.S. 140 in the Bronx, has been matched with a school health coordinator to implement school-wide health screenings and connect kids to timely follow-up medical care and/or social service providers, and a behavioral health clinician to address behavioral/mental health issues. We are also training teachers to identify health barriers to learning and empowering parents by educating and engaging them in their child’s health and academic progress.

Anecdotally, teachers have reported that some students are already improving, both academically and behaviorally, and they have seen a marked gain in pride and confidence. Much of our success at the HRL schools is due to our partnership with school principal assistant principals and other key members of the school community, including the Parent Coordinator, School Nurse, Guidance Counselors, and School Psychologist.

We have learned so much in this first year, and will continue to refine HRL accordingly. For example, the HRL teams report that they are frequently asked to respond to behavioral health crises in the classroom that teachers can, and should be able to, handle. While it is clear that some of the children in “crisis” need specialized behavior interventions, it is also evident that many teachers are not adequately prepared to manage difficult behaviors. In Year 2, we will provide more professional development and skills building training to help teachers better manage a variety of crisis situations. We will also provide in-class coaching sessions for teachers who want or need the extra support.

CHF is also refining protocols for identifying children with specific health barriers. For example, we have created a send-home tool to parents to help identify children who might be struggling with undiagnosed asthma, and we will survey teachers to learn more about the presence and effects of sleepiness and fatigue in the classroom.

Finally, we will work with key members of the school community to strategically address chronic absence (missing a month or more of instruction) by implementing an interdisciplinary team to review attendance data on a weekly basis and implement school-wide and targeted interventions aimed at increasing daily average attendance and reducing the number of students who are chronically absent.

CHF will use data from its NYC pilot project, which will run through 2018, to inform the design of a replicable program that any school, city or state can use to ensure that all of its students are healthy and ready to learn. Through the development and dissemination of materials, such as health screening tools; guidelines for incorporating HRL into schools, health centers and other service sites; and resources for parents, CHF will serve as national resource for communities across the country.

It would be great to meet with the team at Focus for Health to further explore ways we might work together to address health barriers to learning and move forward on addressing the multi-pronged issue of poverty.


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