ERIC Identifier: ED460128
Publication Date: 2001-12-00
Author: Summerfield, Liane M.
Source: ERIC Clearinghouse
on Teaching and Teacher Education Washington DC.
Preparing Classroom Teachers for Delivering Health Instruction.
Children's health and learning are unquestionably linked. Healthy children
are more able to learn and achieve academic success. According to one study
comparing students at low and high risk for food insufficiency, students who
were undernourished scored lower on math tests, were more likely to have been
suspended from school, and had more problems getting along with others (Alaimo,
Olson, & Frongillo, 2001). Conversely, schools that offer physical education
and health education produce students with higher scores on tests of reading,
writing, and mathematics; higher grade point averages; and better attendance
than comparable schools without an emphasis on health (Improving Academic
Schools are often described as being ideal environments for teaching children
about health because they provide access to large numbers of children, are
staffed by professionally trained educators and nurses, and frequently offer
services that promote health, such as nutrition programs and health centers.
This digest examines the preparation of classroom teachers in health and what
teachers should know to effectively provide school health education.
WHO TEACHES HEALTH?
About 90% of the states and school
districts in the United States require some health education for students (Marx,
2001, in press). Fewer than 20% of states and districts require health to be
taught as a separate subject at the elementary level; 28-44% require a separate
subject at the middle school level; and more than half require a separate
subject in high school.
In U.S. elementary schools (grades kindergarten through 5 or 6), health
education is most commonly taught by regular classroom teachers rather than
trained health education specialists. In middle schools (grades 6-8), health is
often taught by regular classroom teachers who have obtained certification in
health, science, home economics, or physical education. At the high school level
(grades 9-12), health education is most often taught by teachers with a health
credential. According to the results of the School Health Policies and Programs
Study (2000), health education specialists are the only teachers who teach
required health education in 25.8% of the senior high schools in the United
States (Kann, Brener, & Allensworth, 2001). However, the 50 states vary
widely in the requirements for obtaining that credential. The evidence is clear:
regular classroom teachers have a significant influence on the quantity and the
quality of health education. In addition, at all levels of education, trusted
teachers of any subject may be seen as health resources by students who need
HOW WELL ARE TEACHERS PREPARED IN HEALTH?
or certification (academic and other requirements teachers must meet to get a
teaching certificate) is governed by the states, and each state may have
different regulations for what teachers need to know to become licensed or
certified. A 1999 survey found that only eight states require coursework in
health for prospective elementary teachers, and four states require health or
physical education coursework; 16 states require elementary teachers to
demonstrate competency or knowledge of health. Half of the states require
coursework in health for middle school teachers (Marx, 2002, in press).
About half of the teacher training programs in the United States are approved
by the National Council for Accreditation of Teacher Education (NCATE). The
NCATE recently released new Program Standards for Elementary Teacher
Preparation, which state (in standard 2g) that teacher education candidates
"must know, understand, and use the major concepts in the subject matter of
health education to create opportunities for student development and practice of
skills that contribute to good health" (NCATE, 2000). This standard can be met
in a different way by each teacher education institution. Some institutions
require one or more health courses for teacher education students, while others
justify using first aid or psychology courses to meet health requirements. It's
no surprise that first year elementary school teachers report considerable
discomfort when teaching health education (Hausman & Ruzek, 1995).
Lack of teacher preparation has been called "a major obstacle to implementing
high-quality school health instruction" (Peterson, Cooper, & Laird, 2001).
Inservice training cannot make up for this. For example, a CDC study examining
HIV/AIDS education found that in states mandating HIV prevention education, only
one-third of teachers attended inservice training on the topic in the past two
years (School-based HIV prevention education, 1994).
WHAT HINDERS TEACHER PREPARATION IN HEALTH?
may account for poor teacher preparation in health:
Lack of time in the teacher education curriculum. The increased demands placed
on teacher education programs to produce teachers who are competent in numerous
subject areas, as well as proficient in classroom management, technology, and
multicultural education, results in fewer hours to devote to subjects seen as
less important, such as health.
Emphasis on standardized testing. Teacher education programs must produce
teachers who are able to prepare students to take state-mandated standardized
tests in math, reading, science, social studies, and several other areas.
Subjects like health, for which standardized testing is rare, may be
de-emphasized in favor of devoting more time to subjects that are tested.
Lack of comfort. Health education includes many sensitive and controversial
topics. Teacher education faculty may find it difficult to overcome their own
discomfort with these topics and fail to prepare student teachers adequately to
address such topics.
WHAT SHOULD TEACHERS KNOW ABOUT HEALTH AND HEALTH
Teachers who will be providing health education need to have
teacher health literacy. This is defined as, "the capacity* to obtain,
interpret, and understand basic health information and services, with the
competence to use such information and services in ways that enhance the
learning of health concepts and skills by school students" (Peterson et al.,
There is no nationally recognized standard for teacher preparation in health
education to achieve health literacy. However, several groups have developed
what they believe such a standard should be.
The Institute of Medicine issued a report in 1997 that recommended substantive
preservice preparation in health education content and methodology for all
elementary teachers. "This preparation should give elementary generalist
teachers strategies for infusing health instruction into the curriculum and
prepare upper elementary teachers to lay the groundwork for the intensive middle
or junior high health education program" (Allensworth, 1997, p. 142).
The American Cancer Society convened a conference in 1992 that made two
recommendations for PreK-12 teacher preparation: that all teacher preparation
programs include content and process courses in health instruction, and that K-6
student teachers in regular and special education be supervised by a health
educator or health coordinator when teaching health lessons. The full report is
printed in the Journal of School Health, January 1993, vol. 63, No. 1.
The American Association for Health Education (AAHE) has developed Health
Instruction Responsibilities for Elementary (K-6) Classroom Teachers, and
Responsibilities of Teachers of Young Adolescents in Coordinated School Health
Programs for Middle School-Level (Grades 5-9) Classroom Teachers. AAHE suggests
there are five responsibilities and 17 competencies at the elementary level and
eight responsibilities and 27 competencies at the middle school level. To access
these, visit their web site www.aahperd.org/aahe/aahe-main.html.
The competencies in health education that are generally recommended for
elementary, middle school, and special education teachers include (Peterson et
Use the National Health Education Standards. Forty of the 50 states use the
National Health Education Standards in curriculum planning (Bennett, Perko,
& Herstine, 2000).
Demonstrate knowledge of community health, consumer health, environmental
health, family life, mental and emotional health, injury prevention and safety,
nutrition, personal health, disease prevention and control, and alcohol,
tobacco, and other drugs.
Incorporate health concepts into other curricular areas.
Develop age-appropriate and culturally relevant health lessons.
Help children develop not only health knowledge but health skills.
Select and use valid and reliable sources of health information.
These competencies may be met by requiring a separate health course for
preservice teachers or by integrating health education into other curricular
areas in the teacher education program (Pateman, 2002; in press). For example, a
children's literature course might include readings from books dealing with
specific diseases, death, and customs. A math methods course might teach math
concepts using health data from federal health databases.
Some type of health education, or "hygiene," has
been a part of American public education for over 100 years. Regular classroom
teachers are the backbone of school health instruction, particularly at the
elementary level. Thus, colleges and universities can directly impact the
quality of health instruction in our public schools by addressing key standards
for health education and incorporating important health concepts into their
teacher preparation curriculum.
References identified with an EJ or ED number
have been abstracted and are in the ERIC database. Journal articles (EJ) should
be available at most research libraries; most documents (ED) are available in
microfiche collections at more than 900 locations. Documents can also be ordered
through the ERIC Document Reproduction Service: (800) 443-ERIC.
Alaimo, K., Olson, C.M., & Frongillo, E.A., Jr. (2001). Food
insufficiency and American school-aged children's cognitive, academic, and
psychosocial development. Pediatrics, 108(1), 44-53.
Allensworth, D., Lawson, E., Nicholson, L., & Wyche, J. (Eds). (1997).
Schools & health: Our nation's investment. Washington DC: National Academy
Press. ED 425 801.
Bennett, J.P., Perko, M.A., & Herstine, J.H. (2000). 1988-1998 national
practices in K-12 health education and physical education teacher certification.
Journal of Health Education, 31(3), 143-14.
Hausman, A.J., & Ruzek, S.B. (1995). Implementation of comprehensive
school health education in elementary schools: Focus on teacher concerns.
Journal of School Health, 65(3), 81-86. EJ 505 813.
Improving academic performance by meeting student health needs. (2000,
October 13). National Governors' Association Issue Brief. Available online at
Kann, L., Brener, N.D., & Allensworth, D.D. (2001). Health education:
Results from the School Health Policies and Programs Study (2000). Journal of
School Health, 71(7), 266-278.
Marx, E. (2002; in press). Matching expectations: What states say that young
people need to know about health and HIV and how well teachers are prepared to
provide it. Washington, DC: AACTE.
National Action Plan for Comprehensive School Health Education. (1993,
January). Journal of School Health, 63(1), 46-66. EJ 469 780.
National Council for Accreditation of Teacher Education [NCATE]. (2000).
Program standards for elementary teacher preparation. Washington, DC: Author.
Available online at http://www.ncate.org
Pateman, B. (2002; in press). Linking national subject area standards with
priority health-risk issues in PK-12 curricula and teacher education programs.
Washington, DC: AACTE.
Peterson, F.L., Cooper, R.J., & Laird, J.M. (2001). Enhancing teacher
health literacy in school health promotion: A vision for the new millennium.
American Journal of School Health, 71(4), 138-144. EJ 625 708.
School-based HIV prevention education - United States, 1994. (1996).
Morbidity and Mortality Weekly Reports, 45(35), 760-766.
The Division of Adolescent and School Health (DASH) of the Centers for
Disease Control and Prevention (CDC) has numerous publications on school health.
Their web address is www.cdc.gov/nccdphp/dash/index.htm. CDC also publishes
Programs that Work at www.cdc.gov/nccdphp/dash/rtc/hiv-curric.htm