Education Policy: Addressing Racial Health Disparities in Educational Contexts

Race, ethnicity, and Socioeconomic Status (SES) influence physical and mental health throughout the life course. Institutional and interpersonal discrimination is particularly detrimental, especially for children, and is associated with poor health outcomes. One of the most important determinants of long-term health is lifelong educational attainment. Center-based Early Childhood Education (ECE) and School-Based Health Centers (SBHCs) can help overcome educational obstacles and increase medical services in disadvantaged populations while fostering health equity. Educators involved in ECE programs and SBHCs for poor and minority youth must be involved in the policy making process in order to ensure that educational quality is considered essential to the long-term effects of health equity.

. As with other forms of early life adversity, discrimination is particularly detrimental to children, with associated poor health outcomes reported in childhood and adolescence increasingly documented internationally (Byrd & Mirken, 2011;Priest et al., 2013;Williams & Anderson, 2016). Institutional and cultural racism can also harm health through stigma, stereotypes, and prejudice all of which can contribute to stunted socioeconomic mobility and reduced access to a broad range of societal resources and opportunities required for health (Williams & Mohammed, 2013).
Racial minorities have a higher risk of exposure to a broad range of psychosocial stressors as well.
Institutional discrimination and socioeconomic disadvantages lead to the overrepresentation of minorities in toxic residential and occupational environments that can lead to risks of exposure to major hardships, conflicts and disruptions such as crime, violence, material deprivation, loss of loved ones, recurrent financial strain, relationship conflicts, unemployment and underemployment (Pager & Shepherd, 2008;Williams & Anderson, 2016). Children from low-income and racial or ethnic minority populations in the U.S. are less likely to have a conventional source of medical care and more likely to develop chronic health problems than are more-affluent and non-Hispanic white children (Knopf et al., 2016).

Educational Interventions
In the U.S., inequities by race, ethnicity, and income in key health outcomes and educational achievement are well documented (Bloom, Cohen, & Freeman, 2012;Hahn et al., 2016). Lifelong educational attainment is one of the most important determinants of long-term health (WHO, 2008;Hahn et al., 2016). Incomplete or poor-quality education can jeopardize a child's prospects for health and well-being. Inequities in health by race and SES highlight the urgent need for a renewed research focus of identifying interventions at multiple societal levels that will be effective in reducing and ultimately eliminating racial inequities in health (Williams & Anderson, 2016).
Center-based Early Childhood Education (ECE) can potentially foster the larger public health goal of health equity, with a focus on low-income and racial and ethnic minority populations in the United States (Hahn et al., 2016). The term health equity refers to a widespread, systematic, achievable equality in health and in the major social determinants of health that benefit all social divisions of a population (Arcaya, M. C., Arcaya, A. L., & Subramanian, 2015;Hahn et al., 2016). ECE programs are defined as programs designed to improve the cognitive or social development of 3and 4-year-old children prior to kindergarten enrollment (Goerge et al., 2015;Hahn et al., 2016).
Programs include an educational component that addresses one or more of the following learning objectives: literacy, numeracy, cognitive development, socio-emotional development, and motor skills.
Eligible programs may offer additional components including recreation, meals, health care, parental supports, and social services. Some programs enroll children younger than 3 years (Hahn et al., 2016). By enhancing social and educational skills before children enter formal schooling, ECE programs strengthen the foundation for ongoing learning, with substantial long-term health benefits. ECE programs are critical for low-income and minority children who have not been exposed to the learning environments generally more available to higher-income families (Hahn et al., 2016;Yen & Lee, 2019).
High-quality ECE programs that increase participation of low-income and racial and ethnic minority children are expected to improve long-term educational and health outcomes and reduce disparities Health outcomes and educational achievement are related to each other in several ways. Health problems (e.g., vision and oral health problems, asthma, teen pregnancy, malnutrition, obesity, chronic stress, and inattention and hyperactivity disorders) and risk-taking behavior (e.g., aggression and violence, unsafe sexual activity, unhealthy eating, physical inactivity, and substance use) are associated  defined as clinics that provide health services to students in pre-Kindergarten through Grade 12.
SBHCs can improve educational and health outcomes through several pathways. Specifically, increased access to and satisfaction with health-related services are expected to increase receipt of recommended services that lead to early detection and treatment or prevention of disease (Knopf et al., 2016). Additionally, benefit is anticipated to extend beyond SBHC users, as many SBHCs offer health education and promotion activities to the entire student body, and non-users may adopt some of the

Education Policy: Massachusetts
Political support is needed to utilize the best available research to reduce social inequalities in health.
Interventions should focus on improving the health of disadvantaged groups more rapidly than the rest of the population so that progress can be made in eliminating inequalities. Many education policies that promise the greatest benefit in improving population health are sometimes likely to actually widen disparities (Mechanic, 2002;Williams & Anderson, 2016).
In Massachusetts, state aid for education is determined by a calculation outlined in Chapter 70 of the Massachusetts General Law. Collectively referred to as "Chapter 70", the statute includes a formula for determining an "adequate" amount of money each district must spend on education, called the foundation budget, and the "equitable" division of state funds to assist each district in meeting their mandated spending level (Britt & Hall, 2009 The program calculates a "foundation budget" for each school district-based on enrollment, student demographics (including grade levels, low-income students, and English language learners), inflation, and local wage levels-to determine the minimum funding needed to provide an adequate education to each student (DeCosta-Klipa, 2019). Every school district then gets a mix of local and state funding.
Based on each municipality's wealth (using property values and personal income), the formula establishes a goal for how much each city or town should be contributing to its foundation budget. All In 2015, state lawmakers established the Foundation Budget Review Commission to review the Chapter 70 formula-and its shortfalls. In a report, the commission found that some of the formula's assumptions can become outdated, resulting in underfunding. The commission found that an achievement gap persisted for low-income students and English Language Learners (ELL). The report stated that many school districts, particularly those with high concentrations of low-income and ELL students, faced "unique costs" and needed additional funding to close the achievement gaps for those group (DeCosta-Klipa, 2019).
Along with a number of additional tweaks to the formula, the PROMISE Act intends take the 2015 commission's recommendations and phase them into law. This bill would increase the base rate of funding schools get for low-income and ELL students by 50 percent to 100 percent per student, depending on the wealth of the district. The legislation would create a data advisory committee made up of education experts and officials focused on streamlining and strengthening school-level staffing, spending, and student demographics "to better inform future policy decisions". Gov. Charlie Baker was expected to introduce legislation to amend the Chapter 70 formula in 2018 and is optimistic that lawmakers will get something passed (DeCosta-Klipa, 2019).

Discussion
In 2015 America have launched initiatives to train current or former teachers in policy analysis and content and to provide them with opportunities to use their voices to influence policy (Brown, 2015). By bringing teachers into the conversation, programs and processes improve the likelihood that policy will be well-designed, well-received, and well-implemented in the classroom. By providing teachers with new challenges and new opportunities, new professional growth opportunities for teachers are created, helping them to receive recognition for their contributions and to stay energized by their profession (Brown, 2015).
There are some important lessons that policymakers should take from the National Network of State Teachers of the Year report. First, policymakers should be selective about the perspectives they seek.
One great aspect of the network of teachers in policy conversations is that all the teachers involved have demonstrated excellence in their field. Second, trust is essential and relationships take time.
Policymakers who seek teachers' input after policies have been formulated are likely to be less well-received than those who put in the time on the front end to cultivate a bond. Third, policy can be complex, and teachers need training to understand how policy shapes their classrooms. Simply asking teachers for their perspective without a strong foundation of knowledge about the frameworks of local, state and federal law is not always going to result in a productive conversation (Brown, 2015).
Racism is an organized system of social stratification that combines with, and even transforms SES to influence health. Action is critically required to address how the health of socially disadvantaged groups is determined by exposures to risks and resources linked to living and working conditions, and how intervening in these contexts can lead to improvements in health.
Educators involved in ECE programs and SBHCs for poor and minority youth must speak with policy makers to address educational quality as an important modifier of the long-term effects of health equity.
Since poor and minority children are likely to live in poor neighborhoods, they are also more likely to attend lower-quality schools. ECE programs and SBHCs improve both educational and health outcomes and must be supported by bills such as the PROMISE Act. Since ECE programs and SBHCs are commonly implemented in low-income communities and communities with high proportions of racial and ethnic minority populations, this source of student health care may be a prominent means of advancing health equity.