Yet schools also lose funding -- because of decreased enrollment -- if children have absences or drop out due to illness. Dr. Pat Cooper, the superintendent of schools in McComb, Miss., thinks the tie between health and performance is obvious: "No Child Left Behind is going to leave a lot of children behind if we don't start looking at the health needs of our students," Cooper says.

When Cooper became superintendent nine years ago, he looked at the high dropout rates, absences from the district's seven schools, and poor test scores. He found a significant link between the health needs of the children and poor performance. "I decided that we had to stop investing in stuff and start investing in people," Cooper says. "We had good teachers, great training, good textbooks. But we realized part of the problem was we weren't reaching kids because the kids weren't in school." The district was plagued with asthma, type 2 diabetes and childhood obesity issues, which cut into students' attendance. Such illnesses are more common among low-income children, which Cooper says describes the majority of students in his district.

Cooper worked with community and health experts to come up with a five-year plan to meet students' health needs and get them back in school. "First we hired two nurses in each school -- not as window dressing, but to treat kids and to do prevention," Cooper says. Daily attendance rates began going up, he says and, consequently, so did the school district's money from the state.

Cooper didn't stop there. He eventually hired master's-level social workers to help manage the emotional and mental health needs of students. Since the majority of students in his district are poor, the schools qualified for a Medicaid-funded clinic on-site. In the McComb School District, dropout rates were 30 percent when Cooper came; now they're down to less than 2 percent, he says.

Dr. Cynthia Mears, who started a school-based health clinic in an immigrant neighborhood in Chicago and three in other states, says that in order to get a clinic or even school nurses in each school, you have to have a champion like Cooper. "The problem is that healthcare isn't always high on a school district's agenda, because they have to answer to test scores," says Mears, who is on the American Academy of Pediatrics School Health Committee. "But you have to have healthy children if they're going to learn."

Regrettably, students in many parts of the country are not as fortunate as the students in McComb, Miss. In Buffalo, this September, Clare McKenna began her sophomore year at City Honors School. Although her mother, Ann McKenna, has worked furiously on state legislation to fund school nurses, her daughter started school with no nurse on-site.

Although Buffalo has one of the highest asthma rates in the nation, New York Gov. George Pataki vetoed a bill in early August that would have funded a nurse in each school in Buffalo and surrounding areas lacking school nurses. It was a bill championed by parents like McKenna, who was outraged by its veto. "We have this beautiful, vital child who goes to a wonderful school that's provided her with perfect potential," McKenna says. "But if kids' primary health concerns are being ignored, how safe are our schools?"

McKenna's advocacy has finally paid off. City Honors High School gained a full-time nurse on Sept. 19, after the local school board agreed to increase the number of nursing positions to 20. Most schools in the district, though, have not fared as well. "Right now I have some schools that don't even see a nurse," says Sue Ventresca, director of health-related services for the Buffalo Public Schools, who says she's hopeful that more money will be found. Presumably, the schools left without nurses feel the same.

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