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The relationship between student health and student achievement — February 2016


What does the research say about the connection between student health and student achievement?


We have prepared the following memo with references on the connection between student health and student achievement. Citations include a link to a free online version, when available. All citations are accompanied by an abstract, excerpt, or summary written by the author or publisher of the document. We also include relevant organizations.

We have not done an evaluation of the methodological rigor of these resources, but provide them for your information only.

Research References

Barr, A. B. (2015). Family socioeconomic status, family health, and changes in students’ math achievement across high school: A mediational model. Social Science & Medicine, 140, 27–34. Retrieved from

Abstract: In response to recent calls to integrate understandings of socioeconomic disparities in health with understandings of socioeconomic disparities in academic achievement, this study tested a mediational model whereby family socioeconomic status predicted gains in academic achievement across high school through its impact on both student and parent health. Data on over 8000 high school students in the U.S. were obtained from wave 1 (2009–2010) and wave 2 (2012) of the High School Longitudinal Study of 2009 (HSLS:09), and structural equation modeling with latent difference scores was used to determine the role of family health problems in mediating the well-established link between family SES and gains in academic achievement. Using both static and dynamic indicators of family SES, support was found for this mediational model. Higher family SES in 9th grade reduced the probability of students and their parents experiencing a serious health problem in high school, thereby promoting growth in academic achievement. In addition, parent and student health problems mediated the effect of changes in family SES across high school on math achievement gains. Results emphasize the importance of considering the dynamic nature of SES and that both student and parent health should be considered in understanding SES-related disparities in academic achievement. This relational process provides new mechanisms for understanding the intergenerational transmission of socioeconomic status and the status attainment process more broadly.

Basch, C. E. (2010). Healthier students are better learners: A missing link in school reforms to close the achievement gap (Research Review No. 6). New York: Campaign for Educational Equality, Teachers College, Columbia University. Retrieved from

Excerpt: No matter how well teachers are prepared to teach, no matter what accountability measures are put in place, no matter what governing structures are established for schools, educational progress will be profoundly limited if students are not motivated and able to learn. Health-related problems play a major role in limiting the motivation and ability to learn of urban minority youth, and interventions to address those problems can improve educational as well as health outcomes. Healthier students are better learners. Recent research in fields ranging from neurosciences and child development to epidemiology and public health provide compelling evidence for the causal role that educationally relevant health disparities play in the educational achievement gap that plagues urban minority youth. This is why reducing these health disparities must be a fundamental part of school reform.

Centers for Disease Control and Prevention. (n.d.). Health and academic achievement. Atlanta, GA: Author. Retrieved from

Excerpt: Schools, health agencies, parents, and communities share a common goal of supporting the link between healthy eating, physical activity, and improved academic achievement of children and adolescents. Evidence shows that the health of students is linked to their academic achievement, so by working together, we can ensure that young people are healthy and ready to learn. Public health and education professionals can use this resource to share the link between healthy eating, physical activity, and improved academic achievement to engage stakeholders in working together to support healthy school environments. This resource includes

  • Evidence linking healthy eating and physical activity with academic achievement.
  • Evidence-driven messages with specific benefits to states, school districts, schools, parents, and students.
  • Specific, feasible, and effective actions to support healthy eating and physical activity in schools.
  • Key resources to learn more.

Coe, D. P., Peterson, T., Blair, C., Schutten, M. C., & Peddie, H. (2013). Physical fitness, academic achievement, and socioeconomic status in school-aged youth. Journal of School Health, 83(7), 500–507. Retrieved from

Abstract: Background: This study examined the association between physical fitness and academic achievement and determined the influence of socioeconomic status (SES) on the association between fitness and academic achievement in school-aged youth. Methods: Overall, 1,701 third-, sixth-, and ninth-grade students from 5 school districts participated in the assessments. Fitness was assessed using FITNESSGRAM (aerobic fitness, muscular strength, muscular endurance, flexibility, and body composition). Results were used to determine individual fitness scores. Academic achievement was measured by standardized tests for Math (all grades), English (all grades), and Social Studies (sixth and ninth grades only). The SES was determined using eligibility for free and reduced lunch program. Results: There were no significant differences between fitness groups for Math and English in third-grade students. Sixth- and ninth-grade students with high fitness scored significantly better on Math and Social Studies tests compared with less fit students. Lower SES students scored significantly worse on all tests. Muscular strength and muscular endurance were significantly associated with academic achievement in all grades. Conclusions: Compared with all other variables, SES appears to have the strongest association with academic achievement. However, it also appears that high fitness levels are positively associated with academic achievement in school-aged youth.

Dilley, J. (2009). Research review: School-based health interventions and academic achievement. Olympia, WA: Washington State Board of Health, Washington State Office of Superintendent of Public Instruction, and Washington State Department of Health. Retrieved from

Excerpt: [This review] provides important new evidence that links students’ health and academic performance. It identifies proven health interventions and practical resources that can positively affect both student health and academic achievement.

Fedewa, A. L., & Davis, M. C. (2015). How food as a reward is detrimental to children’s health, learning, and behavior. Journal of School Health, 85(9), 648–658. Retrieved from

Abstract: Despite small- and wide-scale prevention efforts to curb obesity, the percentage of children classified as overweight and obese has remained relatively consistent in the last decade. As school personnel are increasingly pressured to enhance student performance, many educators use food as a reward to motivate and reinforce positive behavior and high achievement. Yet, many educators have missed the link between student health and academic achievement. Methods: Based on a review of the literature, this article explores the link between childhood obesity and adverse mental and physical health, learning, and behavior outcomes. The role in providing children with food as a reward in the relationship between obesity and detrimental health and performance outcomes are examined. Results: The use of food as a reward is pervasive in school classrooms. Although there is a paucity of research in this area, the few studies published in this area show detrimental outcomes for children in the areas of physical health, learning, and behavior. Conclusions: It is imperative that educators understand the adverse outcomes associated with using food as a reward for good behavior and achievement. This study provides alternatives to using food as a reward and outlines future directions for research.

Fobbs, E. (2015). Promoting student achievement through improved health policy. Alexandria, VA: National Association of State Boards of Education. Retrieved from

Excerpt: School systems improve both student learning and health if they coordinate policy, process, and practice across the 10 dimensions of CDC’s WSCC model: health education; physical education and physical activity; nutrition environment and services; health services; counseling, psychological and social services; employee wellness; social and emotional school climate; family engagement; and community involvement. Much of this work will be done at the district level. However, there are specific tasks that many state boards, working in concert with state education agencies and health departments, can do.

Hanson, T., Austin, G. A., & Lee- Bayha, J. (2004). Ensuring that no child is left behind: How are student health risks & resilience related to the academic progress of schools? San Francisco, CA: WestEd. Retrieved from

Excerpt: Public schools have come under enormous pressure in recent years to demonstrate academic gains and to address deeply rooted disparities among students of different races, ethnic groups, and income levels. Clearly, boosting academic achievement should be a top priority. Less evident, however, is the long-term effect of supporting this goal by diverting attention and funding from programs that have traditionally supported student health and well-being. Over the past decade, research studies and reviews have consistently concluded that student health status and achievement are deeply connected. Evidence has been mounting that meeting the basic developmental needs of students—ensuring that they are safe, drug-free, healthy, and resilient—is central to improving their academic performance. It is time for educators and policymakers to ask some critical questions: Have efforts to boost academic performance overlooked the continuing impact of non-academic barriers to student learning? Even worse, have efforts to raise test scores come at the expense of basic supports for student well-being? Has the pendulum swung so rapidly toward accountability that schools are in danger of losing previous gains? To address these questions—and to shed light on the connections between promoting resilience, reducing health-risk behaviors, and improving academic achievement—WestEd set out to investigate how student health risks and resilience are related to the academic progress of schools. We did this by examining how these factors relate to subsequent changes in academic performance.

Ickovics, J. R., Carroll-Scott, A., Peters, S. M., Schwartz, M., Gilstad-Hayden, K., & McCaslin, C. (2014). Health and academic achievement: Cumulative effects of health assets on standardized test scores among urban youth in the United States. Journal of School Health, 84(1), 40–48. Retrieved from

Abstract: Background: The Institute of Medicine (2012) concluded that we must ‘strengthen schools as the heart of health.’ To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement, and (2) examine cumulative effects of these assets on academic achievement. Methods: Participants include 940 students (grades 5 and 6) from 12 schools randomly selected from an urban district. Data include physical assessments, fitness testing, surveys, and district records. Fourteen health indicators were gathered including physical health (e.g., body mass index [BMI]), health behaviors (e.g., meeting recommendations for fruit/vegetable consumption), family environment (e.g., family meals), and psychological well-being (e.g., sleep quality). Data were collected 3–6 months prior to standardized testing. Results: On average, students reported 7.1 health assets out of 14. Those with more health assets were more likely to be at goal for standardized tests (reading/writing/mathematics), and students with the most health assets were 2.2 times more likely to achieve goal compared with students with the fewest health assets (both p < .001). Conclusions: Schools that utilize nontraditional instructional strategies to improve student health may also improve academic achievement, closing equity gaps in both health and academic achievement.

Michael, S. L., Merlo, C. L., Basch, C. E., Wentzel, K. R., & Wechsler, H. (2015). Critical connections: health and academics. Journal of School Health, 85(11), 740–758. Retrieved from

Abstract: While it is a national priority to support the health and education of students, these sectors must better align, integrate, and collaborate to achieve this priority. This article summarizes the literature on the connection between health and academic achievement using the Whole School, Whole Community, and Whole Child (WSCC) framework as a way to address health-related barriers to learning. Methods: A literature review was conducted on the association between student health and academic achievement. Results: Most of the evidence examined the association between student health behaviors and academic achievement, with physical activity having the most published studies and consistent findings. The evidence supports the need for school health services by demonstrating the association between chronic conditions and decreased achievement. Safe and positive school environments were associated with improved health behaviors and achievement. Engaging families and community members in schools also had a positive effect on students’ health and achievement. Conclusions: Schools can improve the health and learning of students by supporting opportunities to learn about and practice healthy behaviors, providing school health services, creating safe and positive school environments, and engaging families and community. This evidence supports WSCC as a potential framework for achieving national educational and health goals.

National Assembly on School-Based Health Care. (2012). School-based health centers and academic success. Washington, DC: Author. Retrieved from

Abstract: Poor academic outcomes and high dropout rates are major concerns of educators, policymakers, and parents alike—and poor health severely limits a child’s motivation and ability to learn. Recent research confirms that “health disparities affect educational achievement.” Improving students’ health is integral to education reform. “School-Based Health Centers” (“SBHCs”)—the convergence of public health, primary care, and mental health—provide an optimal setting to “foster learning readiness and academic achievement” while giving children the resources they need to improve their health.

Rothstein, R. (2011, March 14). A look at the health-related causes of low student achievement. Washington, DC: Economic Policy Institute. Retrieved from

Excerpt: [EPI Research Associate Richard Rothstein published this exploration of the ways poverty and poor health impact learning, on March 14, 2011, on the Ed100 blog.] The health-related causes of low achievement are unlikely to be remedied without school-based clinics that provide routine and preventive pediatric, dental and vision care in schools serving disadvantaged children from kindergarten through the 12th grade. School-based clinics can provide routine and preventive care without the necessity of parents taking time off from work. School-based clinics, working cooperatively with school comprehensive service coordinators can also ensure that children are seen on a regular and recommended schedule for such care, without the necessity of parent initiative for appointments.

Shaw, S. R., Gomes, P., Polotskaia, A., & Jankowska, A. M. (2015). The relationship between student health and academic performance: Implications for school psychologists. School Psychology International, 36(2), 115–134. Retrieved from

Abstract: Children who are unhealthy are at higher risk for school problems than students who are free from medical problems. Students with poor health have a higher probability of school failure, grade retention, and dropout. The relationship between student health and academic success is complex. Common manageable factors of student health are nutrition, maintaining healthy weight, and physical fitness. Through a comprehensive literature review the relationships among school achievement and nutrition, maintaining healthy weight, and physical fitness are examined. Furthermore, the efficacy of educational programs to improve nutrition, maintain healthy weight, and increase physical fitness is evaluated. The complexity of the relationship among variables is presented and areas for future research and practice for school psychologists are described.

The William and Flora Hewlett Foundation. (n.d.). Healthy steps toward student achievement. Research-based recommendations for policy and practice. Menlo Park, CA: Author. Retrieved from

Excerpt: New research shows that the health and well-being of California’s students have a direct impact on dropout rates, attendance, academic performance and school revenues. The stakes are high and current health indicators raise serious concerns. Student health is critical to our ability to reach achievement goals set by the state—and to advance California’s economic and cultural prosperity. We need to couple commitment to education reform with strategic investments in the well-being of our young people, because we need healthy students to close the achievement gap.

This report reviews research documenting the critical link between student health and well-being—both physical and socio-emotional—and academic success for California students. It also outlines policy actions that can put the research into practice. A four-page overview of research results and policy recommendations is also available. Seven research briefs, undertaken as part of this project, demonstrate a clear nexus between health and well-being and academic success.

The recommended strategies presented in this paper are intended to serve as a catalyst for policy discussions. They range from strengthening direct supports for student health and well-being to improving school environments to strengthening state and local systems that support students’ academic success. Recommendations give special attention to reducing disparities low-income students and students of color experience.

Relevant organizations to consult

ACSD Whole School, Whole Community, Whole Child Model Retrieved from

From the website: Health and education affect individuals, society, and the economy and, as such, must work together whenever possible. Schools are a perfect setting for this collaboration. Schools are one of the most efficient systems for reaching children and youth to provide health services and programs, as approximately 95 percent of all U.S. children and youth attend school. At the same time, integrating health services and programs more deeply into the day-to-day life of schools and students represents an untapped tool for raising academic achievement and improving learning.

Action for Healthy Kids Retrieved from

From the website: Action for Healthy Kids® fights childhood obesity, undernourishment and physical inactivity by helping schools become healthier places so kids can live healthier lives. We partner with a legion of dedicated volunteers—teachers, students, moms, dads, school wellness experts and more—from within the ranks of our 80,000+ network to create healthful school changes. After all, everyone has a part to play in ending the nation’s childhood obesity epidemic. Our grassroots efforts are supported by a collaboration of more than 75 organizations, corporations and government agencies. Working together, we’re giving kids the keys to health and academic success by meeting them where they are—in the classroom, in the cafeteria and on the playground—with fun physical activity and nutrition lessons and changes that make it possible for them to eat nutritiously and play actively every day.

California School-Based Health Alliance Retrieved from

From the website: The California School-Based Health Alliance is the statewide nonprofit organization helping to put more health services in schools. We were formerly known as the California School Health Centers Association (CSHC) until January 2014.

California Healthy Kids Resource Center Retrieved from

From the website: The California Healthy Kids Resource Center (CHKRC) maintains a comprehensive collection of reviewed health education materials for use by teachers, administrators, university faculty, LEA staff and other professionals who work with preschool through 12th grade students in school settings and after-school programs.

School-Based Health Alliance Retrieved from

From the website: Too many children and adolescents experience persistent disparities in health care access, quality, and outcomes. We believe that school-based health care practitioners have distinct child and adolescent health expertise, knowledge, and experiences that should be leveraged to inform and guide systems-level reform in education and health care.

Our purpose is to provide the school-based health care field with help—high-quality resources, training, information, guidance—as well as motivation and inspiration to achieve excellence in their work. We take many approaches to accomplishing this goal:

  • We connect our sector to a national community of peers that shares their values, values their model, and unifies their voice for greater impact.
  • We support our field with common standards, measures, data, and research to demonstrate their value.
  • We engage our members directly in experiential and collaborative learning to lead, test, and spread innovations in the field.
  • We help young people take ownership of their own health.
  • We advocate at federal, state, and local levels for the concept of health and education partnerships broadly—and the school-based health center (SBHC) model specifically—to achieve student well-being and success.

The School-Based Health Alliance believes in the transformational power of health and education when they intersect on behalf of children and adolescents. By empowering school-based health care practitioners, we can redefine health for kids and teens.


Keywords and Search Strings Used in the Search

(“Student well-being” OR “student health”) AND “student achievement”

Search of Databases

ERIC, EBSCO, Google, and Google Scholar

Additional Organizations Searched

Institute of Education Sciences; Doing What Works/What Works Clearinghouse

Criteria for Inclusion

When REL West staff review resources, they consider—among other things—four factors:

  • Date of the Publication: The most current information is included, except in the case of nationally known seminal resources.
  • Source and Funder of the Report/Study/Brief/Article: Priority is given to IES, nationally funded, and certain other vetted sources known for strict attention to research protocols.
  • Methodology: Sources include randomized controlled trial studies, surveys, self-assessments, literature reviews, and policy briefs. Priority for inclusion generally is given to randomized controlled trial study findings, but the reader should note at least the following factors when basing decisions on these resources: numbers of participants (Just a few? Thousands?); selection (Did the participants volunteer for the study or were they chosen?); representation (Were findings generalized from a homogeneous or a diverse pool of participants? Was the study sample representative of the population as a whole?).
  • Existing Knowledge Base: Although we strive to include vetted resources, there are times when the research base is limited or nonexistent. In these cases, we have included the best resources we could find, which may include newspaper articles, interviews with content specialists, organization websites, and other sources.

This memorandum is one in a series of quick-turnaround responses to specific questions posed by educators and policymakers in the West Region (Arizona, California, Nevada, Utah), which is served by the Regional Educational Laboratory West (REL West) at WestEd. This memorandum was prepared by REL West under a contract with the U.S. Department of Education’s Institute of Education Sciences (IES), Contract ED-IES-12-C-0002, administered by WestEd. Its content does not necessarily reflect the views or policies of IES or the U.S. Department of Education nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.