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POVERTY AND THE SCHOOLS* JULIUS B. RICHMOND, M.D. Professor of Health Policy Emeritus Harvard University Boston, Massachusetts
THE CURRENT CRISIS
THERE IS ABROAD IN THE LAND a perception of crisis concerning the education of our children and its long-term implications for our society. Indeed, it is fair to say that there is a crisis -not merely a perception of one. The crisis in our educational system occurs at the same time we see increasing numbers of children and families being added to the poverty rolls. William Julius Wilson has described this well in his book, The Truly Disadvantaged,1 as has David Ellwood in his book, Poor Support: Poverty in the American Family.2 As an observer of how public policy is shaped, I introduce early the caution that when the nation faces a crisis, we tend to look for quick fixes. It behooves us, therefore, to look carefully at how and why we, as a nation, let this crisis develop, consider some health and educational consequences unique to poor children, and outline how schools and communities may better respond to these inordinately complex issues. It is appropriate to document briefly the evidence that we have a crisis. Some evidence of the perception of crisis is reflected in the number of children living in poverty and in the number of reports on education in recent years. In 1988 more than five million children under six were living in poverty (23%).3 One out of every three urban children and one out of every four rural children live in poverty.4 A study comparing poverty in eight industrialized countries found that the United States had the highest child poverty rate and that this rate was two to three times higher than those of most of the other countries studied.5-7 The increase has been particularly striking during the 1980s.8 The poverty rate for children under six is higher than any other age group in the United States, double the rate for adults aged 18-64, and nearly double the rate for the elderly.9 *Presented as part of the 1991 Annual Health Conference, Children at Risk; Poverty and Health, held by the Committee on Medicine in Society of the New York Academy of Medicine May 20 and 21, 1991. Portions of this paper were presented as the first A. Bartlett and Toni S. Giamatti Lecture in Education at Yale University October 25, 1990. The work on which this paper is based was supported in part by an award from the Ronald McDonald Children's Charities.
Bull. N.Y. Acad. Med.
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Children living in poverty are found in all racial groups and regions. Racial breakdown includes 42% white, 32% black, 21% Hispanic, and 5% from other racial groups, primarily Asian and Native Americans. 10 Children in poverty live everywhere-urban, rural, towns and hamlets across the country. Just as in the inner cities, poverty rates in some rural areas have reached 50% and higher and many struggle in suburban communities. For example, Westchester County, one of the 11 wealthiest suburban areas in the country, now has more than 5,000 homeless people looking for shelter. 1' The historical basis for how we have arrived at this crisis point cannot be dealt with adequately here. This is not a time for finger pointing, and there is plenty of blame to go around. But surely our lag in recognizing major demographic changes and acting on them has contributed greatly to our problems. In addition, large groups -mainly people of color -have moved from rural to urban poverty, ethnic and cultural diversity in our society have increased, and there has been a dramatic rise in single-mother families and other alterations in family composition and stability. 12 The decline in purchasing power of low-wage earners and the decline in value of federal income assistance have also contributed. 13 Our national propensity to wear blinders concerning the increasing numbers of poor children, particularly during the last decade, is an issue which, to our shame, we have not yet adequately addressed. The perception of crisis in our educational system is evident in the number of reports on education in recent years. At the National Academy of Science's Forum on the Future of Children and Families we reviewed 22 major reports concerning children in the years 1983 to 1988.14 Of these, six were mainly on education. You know some of the titles: 1983, A Nation at Risk, National Commission on Excellence in Education, US Department of Education;'5 1985, Investing in Our Children, Committee for Economic Development;'6 1986, Time for Results: The Governors' 1991 Report on Education, National Governors' Association;17 1986, A Nation Prepared: Teachers for the 21st Century, Carnegie Forum on Education and the Economy;'8 1987, Children in Need: Investment Strategies for the Educationally Disadvantaged, Committee for Economic Development; '9 1987, Dropouts in America: Enough is Known for Action, Institute for Educational Leadership.20 More recently we have added: 1989, Turning Points: Preparing American Youth for the 21st Century, Carnegie Council on Adolescent Development,2' 1990, The Condition of Teaching: A State-by-State Analysis, Carnegie Foundation for the Advancement of Teaching;22 1990, Code Blue: Uniting for Healthier Youth, The National Commission on the Role of the School and the Community in Improving Adolescent Health, National Association of State Boards of Education, and the American Medical Association.23,57 Vol. 68, No. 1, January-February 1992
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I am not cynical about the numbers of these reports, for in our pluralistic society we seem to need to go through this cumulative process to build consensus. The private sector-especially corporate America-has become very concerned, as it certainly should. One might ask, "What took them so long?" but we should welcome their interest and commitment whenever we get it. The report Children in Need, by the Committee on Economic Development,24 indicates that the leadership in corporate America has attained a high level of sophistication concerning not only the educational needs of children, but the health and social services needs as well. Perhaps the clearest evidence of our national concern has been the president's unprecedented convening of a governors' education summit in Charlottesville during the fall of 1989. Governors have taken the challenge seriously and have formulated goals to be reached by the year 2000, including emphasis on preschool education so that all children enter school ready to learn, more accountability in the schools, emphasis on sciences and mathematics, improved basic skills scores, and more flexibility for parents and students.25 More recently, President Bush sketched his vision for education, lending credence to his wish to be known as "the education president." He and his newly appointed education team-Lamar Alexander, former governor of Tennessee, as Secretary of Education and David Kearns, former chairman of Xerox Corporation, as Deputy Secretary- are calling for overall "higher standards. " The president listed three goals -national testing, school choice, and redistribution of funds with money now reserved for public schools following children to whatever school they choose-public, private, parochial.26 It seems most appropriate to interject a strong word of caution to all who advocate educational reform and see the path of school choice as an effective means to improve our schools and our children's education. 27 In my opinion this is a cop-out. We know that well supported and well conducted schools can do the job. We also know that we have teachers who can do the job. We must not be naive concerning the private sector, which is often assigned a mythical competence. We cannot depend on a move toward privatization to solve our problems. We must remember that it was the private sector that participated in the movement of industry abroad, generated a large trade deficit, and had much to do with the savings and loan and insider trading crises. If we allow school choice to develop as the present administration is advocating, funding for programs like Chapter I of the Elementary and Secondary Education Act, which pays for extra tutoring and special programs for Bull. N.Y. Acad. Med.
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poor children, may be stripped from school systems that have large concentrations of poor children. With all of our problems in public education, we still have public accountability which we should not give up lightly. PRESCHOOL YEARS AND THE VULNERABLE CHILD
Some of the developmental and environmental concerns that our most vulnerable children often face in the preschool years and the impact of these problems on their beginning school in the best sense of the words "ready to learn," are important to address. From the work of the neuroanatomist Conel, when the cortical development over the first few months of life is studied, it is evident there is not an increase in the number of cells, which are fixed at birth, but an increase in arborization among these cells.28 We also know from both experimental and clinical observations that if environments are not stimulating, if they are depriving environments in our conventional sense of the word, somehow or other development does not take place. Profound biological changes begin to occur, and from the studies of infants who manifest the "failure to thrive" syndrome, we know that growth hormones stop being developed.29 Thus, in both the cognitive sense as well as in a true biological sense, these children do not thrive. After the first year, infants who are growing up in disadvantaged environments begin a developmental decline.30 However, in stimulating day care programs developmental declines can be prevented. Recently we have seen the effects of severe deprivation on a large scale among institutionalized infants in Rumania. In a recent study, the multicenter study that the Robert Wood Johnson Foundation supported, children born with low birth weight were provided with more optimal day care environments, mainly after the first year, which were very stimulating in contrast to the control group.3' The infants who received the better environmental treatments and better care clearly demonstrated significant cognitive gains over the children who did not receive such care. Children who came from more advantaged homes did not show the same kinds of differences, since they receive appropriate stimulation without the special programs. The implications of these findings in relation to policy are significant. If these gains observed at three years of age are sustained to school entry, the need for special education should be considerably reduced. Another health issue during the preschool years important to consider at this time concerns what has happened to the childhood immunization initiatives of the late 1970s. During this time, measles were virtually eliminated in Vol. 68, No. 1, January-February 1992
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the United States. But, both because of complacence and erosion of support, and particularly an erosion of the infrastructure in public health, in the last couple of years a very significant increase has occurred, now some 30,000 cases per year.32 It illustrates the importance of our retaining our gains and retaining our vigilance in pursuing public health goals. THE CHALLENGE BEFORE Us
Now that we have the attention of the nation-the private as well as the public sector- the challenge is ours. All of us who are professionals in the various fields of child development have the responsibility to help shape realistic strategies that can be presented to decision-makers for action. I am concerned that this is not happening. Because we are a diverse, pluralistic society with complex relationships among our various levels of government and the private sector we tend to take refuge in marginal, incremental remedies and small demonstrations, rather than facing our challenges boldly and comprehensively. In my view, there is urgency about these issues. The lives of today's children, particularly our most vulnerable children, and the welfare of the nation are at stake; muddling through for several decades will be a great disservice. The Chilean poet Mistral said it well: "Many things we need can wait. The child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being shaped. To him we cannot say tomorrow. His name is today." Therefore, I shall have the temerity to suggest an approach to a comprehensive strategy for improving elementary and secondary education and, in the process, the health and indeed the lives of poor children and their families. I do this with humility, for I am well aware of the sage observation of Sarason that " . . . many failures in school reform result from the fact that many people having a role in, or concern for, educational planning and change possess no intimate knowledge of the culture of the setting they wish to influence and change." 33 The litany of concerns about the educational performance of our poorer youngsters hardly needs repeating. But we can mention briefly the major issues which, fortunately, the National Governor's Association is now focusing on as it develops educational goals: Dropping out of school. According to census figures, about 700,000 young people under the age of 18 are out of school and have not graduated. 34 In 1988 approximately 25% of American high school students left public schools without graduating. In some urban areas, drop-out rates exceed 40%.35,36 Teen-age childbearing poses significant risks of increased school drop-out for young parents.37 Bull. N.Y. Acad. Med.
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Basic literacy skills and work habits. Many children from impoverished backgrounds, but also those from more advantaged groups, lack basic literacy, numeracy, and critical thinking skills.38 Thousands who "earn" a high school diploma do not have the basic literacy skills needed to succeed in today's world. Low academic performance. Education performance of the most needy children and youth is very low (children in urban and rural areas, children of migrant agricultural workers, children in institutions for the neglected and delinquent, homeless children, and those with low literacy skills). Young people most in need of good schools often are least able to find them. Also, many are unable to achieve the high level of mathematics, science, and communication skills required to function effectively in this society.39 Frequent school absences. School attendance is much more erratic and absence more extensive for children in poverty.40 Repeating grades is experienced disproportionately in early school years, and a large proportion fail to complete high school.41,42 Early gains can be lost if children attend schools where environments are not conducive to learning- if, for example, schools lack resources or are illprepared for the children coming from early intervention programs like Head Start, or if teachers stereotype children and have low expectations of academic performance. Poor schools can set any child back, but they are far more devastating for children from disadvantaged backgrounds.43A44 BUILDING ON WHAT WE HAVE LEARNED
Prior to developing a theme for a comprehensive strategy, let me make an important point. The 1990s are not the 1960s. In the interim we have learned a lot about what makes programs work, and we should be applying that knowledge. People like James Comer have done us a great service in developing new models targeted to poor children in urban areas. Comer said that he began to think about how one could make a difference for low-income children and "I decided that the only place you could in our society -because you can't get to families earlier-is in the school,"45 But we can get to children earlier. We are now celebrating the 25th anniversary of the Head Start Program, and we can properly ask, "What have we learned?" I shall address this question briefly. In the process I shall not deal with the details of research on early intervention programs and later outcomes. For our purposes, the major issue is how the program, as a national venture, has survived so well and retained its esprit de corps. It seems to me that we can point to certain generic characteristics of the program which should Vol. 68, No. 1, January-February 1992
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teach us much. These are: i. Comprehensiveness makes a difference. This is not a categorical program; it deals with all aspects of the child's life. It is a comprehensive child development program. ii. Parent involvement is a key ingredient. iii. Governance by the community is basic. It means empowering local groups and trusting the community to do right by its children. iv. Local variations and flexibility keep the program rejuvenated and up to date. v. People do care about children if we give them an opportunity to express their caring through volunteering and governance. What in my view is a deep latent interest among Americans in their children became manifest through the opportunities offered for participation. vi. And we know that the elementary schools need the same comprehensiveness and quality as Head Start. We need to extend the effort to the schools. We also need to have comprehensive child development programs in place prior to the child's entering Head Start. TOWARD A NATIONAL STRATEGY
But let us now turn to the more difficult issues: the challenges facing us in improving the quality of elementary and secondary education in the United States. Historically, there are some unique and important aspects of public support for education. In contrast to many other services, as education became institutionalized in the last century, its governance and financing were concentrated at the state and local levels. In many forums on education, as Sarason has pointed out, "...the initial response seems to be what the federal government should or could do...."46 But in spite of the rapid growth of federal programs for many human services, federal expenditures for education have remained relatively low. Thus, estimated state and local expenditures for 1990-91 total $212.9 billion, while federal expenditures are set at approximately $13.4 billion.47 It is clear that the president and the Secretary of Education have a bully pulpit but few dollars. It is my thesis that for historical and financial reasons this is unlikely to change and that our national strategy must focus on state and local leadership. It is important to dwell for a moment on why this relationship is unlikely to change. Provisions are embedded in the federal constitution adopted in 1788 in which education remained among the "residual powers retained by the states" in contrast to the "enumerated powers" of the national government. Hence each state constitution has provisions and all legislatures have statutory authority for providing for the education of children and youth of the state.48 "Indeed, the provisions vary widely. Connecticut has three brief paragraphs, one of which is more explicit in its commitment to Yale College than to establishing schools. It granted a great deal of latitude for the organization and structure of schools to the General Assembly."49 Bull. N.Y. Acad. Med.
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But we can ask what went wrong, since schools have been governed largely by local boards or committees. The one institution designed to be controlled locally seemed to have lost its course; as a result we have a widespread loss of confidence and disenchantment. Perhaps, after 100 years patterns of governance were becoming obsolete for today's challenges. Certainly there developed preoccupations with financing (which I don't disparage) and often political power. The demographic changes, especially in the large cities, and the profound racial and economic concomitants seem to loom as intractable problems. John Gardner, in his book On Self-Renewal, suggests that even excellent institutions will decline if they do not adapt to change. He states, "There are kinds of excellence -very important kinds that are not necessarily associated with the capacity for self-renewal. A society that has reached heights of excellence may already be caught up on the rigidities that will bring it down. An institution may hold itself to the highest standards and yet already be entombed in the complacency that will eventually spell its decline."50 As recognition was growing that we were facing a crisis, we responded in a typically American way. We set up numerous commissions, and we began to break the problems into component parts. Thus, some reports emphasized financing, others teacher preparation and competence, others curriculum, and yet others organization and structure in governance. Another typical and important response has been the establishment -often with support from private sources -of numerous demonstration programs that show us that with high motivation, creative reorganization, deep community support, and often a charismatic leader we can achieve excellent results. Indeed, the newspapers almost daily describe such programs. It is, of course, carrying coal to Newcastle to note the significance of Dr. James Comer's pioneering efforts in New Haven which are now receiving so much national attention. We could mention what the Rochester Schools are doing and many others.51 ,52 If we have the successful demonstrations, why haven't we moved beyond where we are? My thesis is that, from Head Start and from these numerous successful demonstrations, we know what works, but we haven't learned how to engineer widespread social and institutional change. Our problems relate to our incapacity thus far to disseminate these models into larger scale programs. Basically, we have the knowledge base, and to a considerable extent we have the political will. The third component for shaping public policy-a social strategy-has been lacking. Certainly, as professionals we have not been effective social strategists. Let us turn our attention to developing such a strategy. What specifically are the steps to be taken to move our efforts at educaVol. 68, No. 1, January-February 1992
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tional improvement forward in a bold and expeditious way? I would suggest the following. The National Governors Association should declare each governor the "education governor" for the decade of the 1990s. Although the president has declared himself the "education president," this is largely a bully pulpit statement. The governors have much of the authority and the resources with which to influence the process of change. The National Governors Association should adopt its "Goals for the Year 2000" and disseminate these widely. There is good precedent in health in establishing such goals decennially and assessing progress. While it is true that it is difficult to gain wide agreement on goals, if they are macro rather than micro they can achieve their purpose. Proceeding without a set of goals is analogous to going to sea without a set of charts. The governors should charge local school authorities with developing a plan to translate goals into local programs. These should be tailored to meet local needs and, collaboratively with the state department of education, evaluations should be planned to assess progress. Integration of health and other child care services must be intimately interwoven with educational efforts. I would be remiss if I didn't again emphasize that health and education are indivisible. Poor health inhibits good learning, and a poorly educated child inhibits good health. We have not yet attained a comprehensive child health care system, just as we do not have a universal child care system for young children. Continuity among such programs is essential, and Zigler has emphasized this well.53 A recent National Commission on the Role of the School and the Community in Improving Adolescent Health established jointly by the National Association of State Boards of Education and the American Medical Association is an example of collaborative activity which should be encouraged.54 Health services should be complemented by health education. We are only on the threshold of bringing these together with education more fully. What has become apparent is that educators, especially those in large city school systems, recognize that without well developed health and social services, their efforts are immeasurably more difficult. Support school-based management with community participation. The governors should take cognizance of the disenchantment of teachers and administrators with what is perceived as insensitive bureaucracy in school governance. This takes the form of an emphasis on school-based management in which administrators, teachers, and students play a much more significant role in determining school policies and operations. Bull. N.Y. Acad. Med.
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We know from studies such as those of Rutter in England55 that student performance and behavior improve with school characteristics which apply sound social and cognitive learning principles. These characteristics are easier to define than to implement, but we know them well: Ample use of rewards, praise and appreciation, a pleasant and comfortable environment, opportunities for students to take responsibility and to participate in the running of their school, an appropriate emphasis on academic matters, positive teacher models, good classroom management, and effective school staff organization. But I hasten to add that involvement of teachers, administrators, and students is not enough. If Head Start has taught us anything, it is that community participation is the key to local commitment which will sustain efforts at improvement. It is clear that governors have been moving in this direction. In several states where local community participation has been eroded, neglected, or corrupted, state departments of education have moved in-in the public interest-and are attempting to restore a more genuine representation and participation at the local level. Kentucky and New Jersey are examples of different approaches to a distribution of resources and control. We need a more creative tension between the state and local efforts. While the state officials may be perceived as intrusive, without some public accountability local school programs may drift. An important corollary, again drawn from the Head Start experience, is that state officials should have confidence that if the local community is truly represented in school governance, the efforts to improve the lives of children and families will become increasingly effective. We must have confidence that all communities have the capacity to improve their schools. The corollary is that such efforts should not await a "charismatic leader." Again I draw on our Head Start experience in which we initiated 2,700 programs across the United States in one summer. If we were to await the charismatic figures for each of these we still would be waiting. It is impressive as one travels about the country that one finds so much talent. Our task is to provide the support systems to catalyze their efforts. Provide technical assistance from state departments of education in collaboration with universities. While I don't want to sound anti-intellectual by suggesting we don't need new knowledge-for we always do-my main thesis is that we have ample demonstrations which provide models for successful outcomes. Zigler has outlined what the school of the 21st century should look like; Gardner has written of the generic ingredients of successful Vol. 68, No. 1, January-February 1992
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curricula for teaching literacy, numeracy, and critical thinking; and Comer and others have demonstrated how one develops effective compacts among citizens, parents, teachers, and administrators for an integrated, effective program at the local level. I don't dwell on curriculum or improving the quality of teaching, for these have been effectively upgraded in many communities, but tailoring these efforts must be local. While such technical assistance seems like a vast challenge, much expertise exists in the nation. Collaborative efforts with the universities could enhance the capacity of the departments of education. Indeed, many demonstrations of university involvement in local school programs are on record. We need to develop a multiplier effect from the many successful demonstrations. We must demonstrate a commitment to a redistribution of resources. This surely will be required if we are to improve the schools in areas of concentrated poverty -often characterized by minority group status. The patterns of financing for the schools established decades ago are no longer functional for meeting the needs of our children at greatest risk. We can no longer afford to sweep the problems of one fourth of our children under the rug. At a recent annual meeting of the Children's Defense Fund, Marian Wright Edelman said that Congress, the states, and local communities must rewrite the options of opportunity for all our children, but especially for our poor children. We must be willing to write the checks that guarantee poor children a real chance of success from the moment they are conceived until the moment they receive as much education as they can absorb. Only then will the tragedy of children deprived from birth of a dignified life be banished forever from this land.56 Some efforts are already under way to arrive at these adjustments in some states and we already recognize the political hazards involved as more affluent communities view these efforts as depriving them of resources. Leadership will be required to generate the political will. It is also appropriate to note that this may provide a realistic role for the federal government, since its investment in elementary education is largely through the Elementary and Secondary Education Act designed to improve school programs for lowincome populations. Involve the private sector for continued support. The leaders of corporate America recognize that rebuilding our competitive position depends heavily on the extent to which we educate our children effectively. Compacts with industry can do much to complement the efforts of the schools. Also, much of the political will at the national, state, and local level of the schools depends on leadership from the private sector. Bull. N.Y. Acad. Med.
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CONCLUSION
The national consensus that we are at a critical period in education suggests urgency in developing strategies for reform. Fortunately, we have come through a period of moving toward upgrading the status of teachers, the development of curricula with sounder approaches to enhancing learning, and numerous successful demonstration programs which provide models for enhancing effectiveness. These models tend to be comprehensive, bringing together educational, social, and health services with school-based management and community participation and commitment. What seems essential now is the transformation of these successful programs into widespread social and institutional change. Building on 25 years of Head Start experience we have learned that local, community-based governance can be effective in meeting the needs of children and families. What is proposed, therefore, is not a categorical approach to school reform, but rather a process of state-local community relationships which may serve to engineer the changes on a larger scale. We need to act boldly, for we cannot afford to muddle through. REFERENCES 1. Wilson, W.J.: The Truly Disadvantaged. Chicago, University of Chicago Press, 1987. 2. Ellwood, D.T.: Poor Support: Poverty in the American Family. New York, Basic Books, 1988. 3. National Center for Children in Poverty: Five Million Children: A Statistical Profile of our Poorest Young Citizens. 1990. 4. Reed S. and Sauter, R.C. Children of Poverty: The status of 12 million young americans. Phi Delta Kappan: June 1990. 5. National Commission on the Role of the School and the Community In Improving Adolescent Health: Code Blue: Uniting for Healthier Youth. Alexandria, VA, National Association of State Boards of Education, 1990, p. 6. 6. Klerman, L.V.: Alive and Well? A Research and Policy Review of Health Programs for Poor Young Children. New York, National Center for Children in Poverty, 1991. 7. Bane, M.J. and Ellwood, D.T.: One fifth of the nation's children: why are they poor? Science 245:1047-53, 1989.
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8. US House of Representatives: US Children and Their Families: Current Conditions and Recent Trends. Washington, D.C., Govt. Print. Off., 1989. 9. US Bureau of the Census: Money, Income and Poverty Status in the US, 1989. Current Population Reports, Series P-60, no 168. Washington, D.C., Govt. Print. Off., 1990. 10. Klerman, L.V., op cit. 11. Reed, S. andSauter, R.C., opcit. 12. Klerman, L.V., op cit. 13. Klerman, L.V., op cit. 14. Both, D.R. and Garduque, L.: 1989. Social Policy for Children and Families: Creating an Agenda. A Review of Selected Papers. Washington, D.C., Nat. Acad. Press, 1989. 15. National Commission on Excellence in Education: A Nation at Risk. Washington, D.C., Govt. Print. Off., 1983. 16. Committee for Economic Development: Investing in Our Children. New York, Committee for Economic Development, 1985. 17. National Governors Assn: Time for Results: The Governors' 1991 Report on
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Education. Washington, D.C., Nat. Governors Assn., 1986. 18. Carnegie Forum on Education and the Economy, Task Force on Teaching as a Profession: A Nation Prepared: Teachers for the 21st Century. New York, Carnegie Forum on Education and the Economy, 1986. 19. Committee for Economic Development, Research and Policy Committee: Children in Need: Investment Strategies for the Educationally Disadvantaged. New York, Committee for Economic Development, 1987. 20. Institute for Educational Leadership: Dropouts in America: Enough is Known for Action. Washington, D.C., Institute for Educational Leadership, 1987. 21. Carnegie Council on Adolescent Development: Turning Points: Preparing American Youth for the 21st Century. New York, Carnegie Corporation of New York, 1989. 22. Carnegie Foundation for the Advancement of Teaching: The Condition of Teaching: A State-by-State Analysis. Lawrenceville, NJ, Princeton University Press, 1990. 23. National Commission on the Role of the School and the Community in Improving Adolescent Health, op cit. 24. Committee on Economic Development, op cit. 25. Task Force on Education: Educating America: State Strategies for Achieving the National Educational Goals. A Report. Washington, D.C., National Governors Assn., 1990. 26. New York Times. April 20, 1991. 27. Chubb, J.E. and Moe, T.M.: Politics, Markets and America's Schools. Washington, D.C., Brookings Institute, 1990. 28. Conel, J.L.: The Brain Structure of the Newborn Infant and Consideration of the Senile Brain. In: Association for Research in Nervous and Mental Disease, Vol. 19: The Inter-relationship of Mind and Body. Baltimore, Williams & Wilkins, 1939. 29. Bithoney, W.G.: Failure to Thrive. In:
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dren: what have they compelled us to learn? Yale J. Biol. Med. 43:127-44, 1970. The Infant Health and Development Program: Enhancing the outcomes of lowbirth-weight, premature infants: a multisite, randomized trial. J.A.M.A. 263:3035-42, 1990. Panel ties measles epidemic to breakdown in health system. New York Times, January 9, 1991. Sarason, S.B.: The Culture ofthe School and the Problem ofChange. Boston, Allyn & Bacon, 1971, p. 8. Dryfoos, J.G.: Adolescents at Risk: Prevalence and Prevention. New York, Oxford University Press, 1990. Vanderpool, N.A. and Richmond, J.B.: Child health in the United States: prospects for the 1990s. Ann. Rev. Public Health 11:185-205, 1990. Fine, M. and Zane, N.: Bein' Wrapped Too Tight: When Low-Income Women Drop Out of School. In: Dropouts from School. Weis, L., Farrar, R., and Petrie, H., editors. New York, SUNY Press, 1989. National Health/Education Consortium: Healthy Brain Development: Precursor to Learning. Washington, D.C., Nat. Commission to Prevent Infant Mortality, 1991, p. 3. Gardner, H.: The difficulties of school: probable causes, possible cures. Daedalus 119:85-113, 1990. Dryfoos, J.G.: Youth At Risk: One in Four in Jeopardy. New York, Carnegie Foundation, 1987. Ravitch, D. and Finn, C.: What Do Our 17 Year Olds Know? New York, Harper and Row, 1987. Knapp, M.S. and Shields, P.M.: Reconceiving Academic Instruction for the Children of Poverty. Phi Delta Kappan: June 1990. 753-58, 1990. National Committee on the Role of the School and the Community in Improving Adolescent Health, op cit. National Health/Education Consortium, op cit. Rutter, M.: School effects on pupil progress: research finding and policy implications. Child Dev. 54;1-29, 1983. Goldberg, M.: Portrait of James P. Bull. N.Y. Acad. Med.
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49. 50. 51.
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Comer. Educational Leadership:40-42, children. Sci. Am. 259:42-48, 1988. September 1990. 52. Gardner, H., op cit. Sarason, S.B., op cit. 53. Zigler, E.F. and Lang, M.E.: The Snyder, T.D.: Digest of Education StaSchool of the 21st Century: A Step totistics, 25th ed. Center for Education ward a Unified System of Child Care and Statistics. Washington, D.C., Govt. Family Support. In: Child Chare Print. Off., 1989. Choices: Balancing the Needs of ChilCollins, G.: Constitutional and Legal dren, Families, and Society, Zigler, Basis for State Action In: Education in E.F. and Lang, M.E., editors. New the States: Nationwide Development York, Free Press, 1990. since 1900, Fuller, E. and Pearson, J., 54. National Commission on the Role of the editors. Washington, D.C., Nat. EducaSchool and the Community in Improving tion Association of the United States, Adolescent Health, op cit. 1969. 55. Rutter, M., op cit. Collins, G., op cit. 56. Reed, S. and Sauter, R.C., op cit. Gardner, J.: On Self-Renewal. New 57. National Commission on Children: BeYork, Harper & Row, 1964. yond Rhetoric: A New American Agenda Comer, J.P.: Educating poor minority for Children and Families. 1991.
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POVERTY AND THE SCHOOLS* JULIUS B. RICHMOND, M.D. Professor of Health Policy Emeritus Harvard University Boston, Massachusetts
THE CURRENT CRISIS
THERE IS ABROAD IN THE LAND a perception of crisis concerning the education of our children and its long-term implications for our society. Indeed, it is fair to say that there is a crisis -not merely a perception of one. The crisis in our educational system occurs at the same time we see increasing numbers of children and families being added to the poverty rolls. William Julius Wilson has described this well in his book, The Truly Disadvantaged,1 as has David Ellwood in his book, Poor Support: Poverty in the American Family.2 As an observer of how public policy is shaped, I introduce early the caution that when the nation faces a crisis, we tend to look for quick fixes. It behooves us, therefore, to look carefully at how and why we, as a nation, let this crisis develop, consider some health and educational consequences unique to poor children, and outline how schools and communities may better respond to these inordinately complex issues. It is appropriate to document briefly the evidence that we have a crisis. Some evidence of the perception of crisis is reflected in the number of children living in poverty and in the number of reports on education in recent years. In 1988 more than five million children under six were living in poverty (23%).3 One out of every three urban children and one out of every four rural children live in poverty.4 A study comparing poverty in eight industrialized countries found that the United States had the highest child poverty rate and that this rate was two to three times higher than those of most of the other countries studied.5-7 The increase has been particularly striking during the 1980s.8 The poverty rate for children under six is higher than any other age group in the United States, double the rate for adults aged 18-64, and nearly double the rate for the elderly.9 *Presented as part of the 1991 Annual Health Conference, Children at Risk; Poverty and Health, held by the Committee on Medicine in Society of the New York Academy of Medicine May 20 and 21, 1991. Portions of this paper were presented as the first A. Bartlett and Toni S. Giamatti Lecture in Education at Yale University October 25, 1990. The work on which this paper is based was supported in part by an award from the Ronald McDonald Children's Charities.
Bull. N.Y. Acad. Med.
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Children living in poverty are found in all racial groups and regions. Racial breakdown includes 42% white, 32% black, 21% Hispanic, and 5% from other racial groups, primarily Asian and Native Americans. 10 Children in poverty live everywhere-urban, rural, towns and hamlets across the country. Just as in the inner cities, poverty rates in some rural areas have reached 50% and higher and many struggle in suburban communities. For example, Westchester County, one of the 11 wealthiest suburban areas in the country, now has more than 5,000 homeless people looking for shelter. 1' The historical basis for how we have arrived at this crisis point cannot be dealt with adequately here. This is not a time for finger pointing, and there is plenty of blame to go around. But surely our lag in recognizing major demographic changes and acting on them has contributed greatly to our problems. In addition, large groups -mainly people of color -have moved from rural to urban poverty, ethnic and cultural diversity in our society have increased, and there has been a dramatic rise in single-mother families and other alterations in family composition and stability. 12 The decline in purchasing power of low-wage earners and the decline in value of federal income assistance have also contributed. 13 Our national propensity to wear blinders concerning the increasing numbers of poor children, particularly during the last decade, is an issue which, to our shame, we have not yet adequately addressed. The perception of crisis in our educational system is evident in the number of reports on education in recent years. At the National Academy of Science's Forum on the Future of Children and Families we reviewed 22 major reports concerning children in the years 1983 to 1988.14 Of these, six were mainly on education. You know some of the titles: 1983, A Nation at Risk, National Commission on Excellence in Education, US Department of Education;'5 1985, Investing in Our Children, Committee for Economic Development;'6 1986, Time for Results: The Governors' 1991 Report on Education, National Governors' Association;17 1986, A Nation Prepared: Teachers for the 21st Century, Carnegie Forum on Education and the Economy;'8 1987, Children in Need: Investment Strategies for the Educationally Disadvantaged, Committee for Economic Development; '9 1987, Dropouts in America: Enough is Known for Action, Institute for Educational Leadership.20 More recently we have added: 1989, Turning Points: Preparing American Youth for the 21st Century, Carnegie Council on Adolescent Development,2' 1990, The Condition of Teaching: A State-by-State Analysis, Carnegie Foundation for the Advancement of Teaching;22 1990, Code Blue: Uniting for Healthier Youth, The National Commission on the Role of the School and the Community in Improving Adolescent Health, National Association of State Boards of Education, and the American Medical Association.23,57 Vol. 68, No. 1, January-February 1992
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I am not cynical about the numbers of these reports, for in our pluralistic society we seem to need to go through this cumulative process to build consensus. The private sector-especially corporate America-has become very concerned, as it certainly should. One might ask, "What took them so long?" but we should welcome their interest and commitment whenever we get it. The report Children in Need, by the Committee on Economic Development,24 indicates that the leadership in corporate America has attained a high level of sophistication concerning not only the educational needs of children, but the health and social services needs as well. Perhaps the clearest evidence of our national concern has been the president's unprecedented convening of a governors' education summit in Charlottesville during the fall of 1989. Governors have taken the challenge seriously and have formulated goals to be reached by the year 2000, including emphasis on preschool education so that all children enter school ready to learn, more accountability in the schools, emphasis on sciences and mathematics, improved basic skills scores, and more flexibility for parents and students.25 More recently, President Bush sketched his vision for education, lending credence to his wish to be known as "the education president." He and his newly appointed education team-Lamar Alexander, former governor of Tennessee, as Secretary of Education and David Kearns, former chairman of Xerox Corporation, as Deputy Secretary- are calling for overall "higher standards. " The president listed three goals -national testing, school choice, and redistribution of funds with money now reserved for public schools following children to whatever school they choose-public, private, parochial.26 It seems most appropriate to interject a strong word of caution to all who advocate educational reform and see the path of school choice as an effective means to improve our schools and our children's education. 27 In my opinion this is a cop-out. We know that well supported and well conducted schools can do the job. We also know that we have teachers who can do the job. We must not be naive concerning the private sector, which is often assigned a mythical competence. We cannot depend on a move toward privatization to solve our problems. We must remember that it was the private sector that participated in the movement of industry abroad, generated a large trade deficit, and had much to do with the savings and loan and insider trading crises. If we allow school choice to develop as the present administration is advocating, funding for programs like Chapter I of the Elementary and Secondary Education Act, which pays for extra tutoring and special programs for Bull. N.Y. Acad. Med.
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poor children, may be stripped from school systems that have large concentrations of poor children. With all of our problems in public education, we still have public accountability which we should not give up lightly. PRESCHOOL YEARS AND THE VULNERABLE CHILD
Some of the developmental and environmental concerns that our most vulnerable children often face in the preschool years and the impact of these problems on their beginning school in the best sense of the words "ready to learn," are important to address. From the work of the neuroanatomist Conel, when the cortical development over the first few months of life is studied, it is evident there is not an increase in the number of cells, which are fixed at birth, but an increase in arborization among these cells.28 We also know from both experimental and clinical observations that if environments are not stimulating, if they are depriving environments in our conventional sense of the word, somehow or other development does not take place. Profound biological changes begin to occur, and from the studies of infants who manifest the "failure to thrive" syndrome, we know that growth hormones stop being developed.29 Thus, in both the cognitive sense as well as in a true biological sense, these children do not thrive. After the first year, infants who are growing up in disadvantaged environments begin a developmental decline.30 However, in stimulating day care programs developmental declines can be prevented. Recently we have seen the effects of severe deprivation on a large scale among institutionalized infants in Rumania. In a recent study, the multicenter study that the Robert Wood Johnson Foundation supported, children born with low birth weight were provided with more optimal day care environments, mainly after the first year, which were very stimulating in contrast to the control group.3' The infants who received the better environmental treatments and better care clearly demonstrated significant cognitive gains over the children who did not receive such care. Children who came from more advantaged homes did not show the same kinds of differences, since they receive appropriate stimulation without the special programs. The implications of these findings in relation to policy are significant. If these gains observed at three years of age are sustained to school entry, the need for special education should be considerably reduced. Another health issue during the preschool years important to consider at this time concerns what has happened to the childhood immunization initiatives of the late 1970s. During this time, measles were virtually eliminated in Vol. 68, No. 1, January-February 1992
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the United States. But, both because of complacence and erosion of support, and particularly an erosion of the infrastructure in public health, in the last couple of years a very significant increase has occurred, now some 30,000 cases per year.32 It illustrates the importance of our retaining our gains and retaining our vigilance in pursuing public health goals. THE CHALLENGE BEFORE Us
Now that we have the attention of the nation-the private as well as the public sector- the challenge is ours. All of us who are professionals in the various fields of child development have the responsibility to help shape realistic strategies that can be presented to decision-makers for action. I am concerned that this is not happening. Because we are a diverse, pluralistic society with complex relationships among our various levels of government and the private sector we tend to take refuge in marginal, incremental remedies and small demonstrations, rather than facing our challenges boldly and comprehensively. In my view, there is urgency about these issues. The lives of today's children, particularly our most vulnerable children, and the welfare of the nation are at stake; muddling through for several decades will be a great disservice. The Chilean poet Mistral said it well: "Many things we need can wait. The child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being shaped. To him we cannot say tomorrow. His name is today." Therefore, I shall have the temerity to suggest an approach to a comprehensive strategy for improving elementary and secondary education and, in the process, the health and indeed the lives of poor children and their families. I do this with humility, for I am well aware of the sage observation of Sarason that " . . . many failures in school reform result from the fact that many people having a role in, or concern for, educational planning and change possess no intimate knowledge of the culture of the setting they wish to influence and change." 33 The litany of concerns about the educational performance of our poorer youngsters hardly needs repeating. But we can mention briefly the major issues which, fortunately, the National Governor's Association is now focusing on as it develops educational goals: Dropping out of school. According to census figures, about 700,000 young people under the age of 18 are out of school and have not graduated. 34 In 1988 approximately 25% of American high school students left public schools without graduating. In some urban areas, drop-out rates exceed 40%.35,36 Teen-age childbearing poses significant risks of increased school drop-out for young parents.37 Bull. N.Y. Acad. Med.
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Basic literacy skills and work habits. Many children from impoverished backgrounds, but also those from more advantaged groups, lack basic literacy, numeracy, and critical thinking skills.38 Thousands who "earn" a high school diploma do not have the basic literacy skills needed to succeed in today's world. Low academic performance. Education performance of the most needy children and youth is very low (children in urban and rural areas, children of migrant agricultural workers, children in institutions for the neglected and delinquent, homeless children, and those with low literacy skills). Young people most in need of good schools often are least able to find them. Also, many are unable to achieve the high level of mathematics, science, and communication skills required to function effectively in this society.39 Frequent school absences. School attendance is much more erratic and absence more extensive for children in poverty.40 Repeating grades is experienced disproportionately in early school years, and a large proportion fail to complete high school.41,42 Early gains can be lost if children attend schools where environments are not conducive to learning- if, for example, schools lack resources or are illprepared for the children coming from early intervention programs like Head Start, or if teachers stereotype children and have low expectations of academic performance. Poor schools can set any child back, but they are far more devastating for children from disadvantaged backgrounds.43A44 BUILDING ON WHAT WE HAVE LEARNED
Prior to developing a theme for a comprehensive strategy, let me make an important point. The 1990s are not the 1960s. In the interim we have learned a lot about what makes programs work, and we should be applying that knowledge. People like James Comer have done us a great service in developing new models targeted to poor children in urban areas. Comer said that he began to think about how one could make a difference for low-income children and "I decided that the only place you could in our society -because you can't get to families earlier-is in the school,"45 But we can get to children earlier. We are now celebrating the 25th anniversary of the Head Start Program, and we can properly ask, "What have we learned?" I shall address this question briefly. In the process I shall not deal with the details of research on early intervention programs and later outcomes. For our purposes, the major issue is how the program, as a national venture, has survived so well and retained its esprit de corps. It seems to me that we can point to certain generic characteristics of the program which should Vol. 68, No. 1, January-February 1992
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teach us much. These are: i. Comprehensiveness makes a difference. This is not a categorical program; it deals with all aspects of the child's life. It is a comprehensive child development program. ii. Parent involvement is a key ingredient. iii. Governance by the community is basic. It means empowering local groups and trusting the community to do right by its children. iv. Local variations and flexibility keep the program rejuvenated and up to date. v. People do care about children if we give them an opportunity to express their caring through volunteering and governance. What in my view is a deep latent interest among Americans in their children became manifest through the opportunities offered for participation. vi. And we know that the elementary schools need the same comprehensiveness and quality as Head Start. We need to extend the effort to the schools. We also need to have comprehensive child development programs in place prior to the child's entering Head Start. TOWARD A NATIONAL STRATEGY
But let us now turn to the more difficult issues: the challenges facing us in improving the quality of elementary and secondary education in the United States. Historically, there are some unique and important aspects of public support for education. In contrast to many other services, as education became institutionalized in the last century, its governance and financing were concentrated at the state and local levels. In many forums on education, as Sarason has pointed out, "...the initial response seems to be what the federal government should or could do...."46 But in spite of the rapid growth of federal programs for many human services, federal expenditures for education have remained relatively low. Thus, estimated state and local expenditures for 1990-91 total $212.9 billion, while federal expenditures are set at approximately $13.4 billion.47 It is clear that the president and the Secretary of Education have a bully pulpit but few dollars. It is my thesis that for historical and financial reasons this is unlikely to change and that our national strategy must focus on state and local leadership. It is important to dwell for a moment on why this relationship is unlikely to change. Provisions are embedded in the federal constitution adopted in 1788 in which education remained among the "residual powers retained by the states" in contrast to the "enumerated powers" of the national government. Hence each state constitution has provisions and all legislatures have statutory authority for providing for the education of children and youth of the state.48 "Indeed, the provisions vary widely. Connecticut has three brief paragraphs, one of which is more explicit in its commitment to Yale College than to establishing schools. It granted a great deal of latitude for the organization and structure of schools to the General Assembly."49 Bull. N.Y. Acad. Med.
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But we can ask what went wrong, since schools have been governed largely by local boards or committees. The one institution designed to be controlled locally seemed to have lost its course; as a result we have a widespread loss of confidence and disenchantment. Perhaps, after 100 years patterns of governance were becoming obsolete for today's challenges. Certainly there developed preoccupations with financing (which I don't disparage) and often political power. The demographic changes, especially in the large cities, and the profound racial and economic concomitants seem to loom as intractable problems. John Gardner, in his book On Self-Renewal, suggests that even excellent institutions will decline if they do not adapt to change. He states, "There are kinds of excellence -very important kinds that are not necessarily associated with the capacity for self-renewal. A society that has reached heights of excellence may already be caught up on the rigidities that will bring it down. An institution may hold itself to the highest standards and yet already be entombed in the complacency that will eventually spell its decline."50 As recognition was growing that we were facing a crisis, we responded in a typically American way. We set up numerous commissions, and we began to break the problems into component parts. Thus, some reports emphasized financing, others teacher preparation and competence, others curriculum, and yet others organization and structure in governance. Another typical and important response has been the establishment -often with support from private sources -of numerous demonstration programs that show us that with high motivation, creative reorganization, deep community support, and often a charismatic leader we can achieve excellent results. Indeed, the newspapers almost daily describe such programs. It is, of course, carrying coal to Newcastle to note the significance of Dr. James Comer's pioneering efforts in New Haven which are now receiving so much national attention. We could mention what the Rochester Schools are doing and many others.51 ,52 If we have the successful demonstrations, why haven't we moved beyond where we are? My thesis is that, from Head Start and from these numerous successful demonstrations, we know what works, but we haven't learned how to engineer widespread social and institutional change. Our problems relate to our incapacity thus far to disseminate these models into larger scale programs. Basically, we have the knowledge base, and to a considerable extent we have the political will. The third component for shaping public policy-a social strategy-has been lacking. Certainly, as professionals we have not been effective social strategists. Let us turn our attention to developing such a strategy. What specifically are the steps to be taken to move our efforts at educaVol. 68, No. 1, January-February 1992
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tional improvement forward in a bold and expeditious way? I would suggest the following. The National Governors Association should declare each governor the "education governor" for the decade of the 1990s. Although the president has declared himself the "education president," this is largely a bully pulpit statement. The governors have much of the authority and the resources with which to influence the process of change. The National Governors Association should adopt its "Goals for the Year 2000" and disseminate these widely. There is good precedent in health in establishing such goals decennially and assessing progress. While it is true that it is difficult to gain wide agreement on goals, if they are macro rather than micro they can achieve their purpose. Proceeding without a set of goals is analogous to going to sea without a set of charts. The governors should charge local school authorities with developing a plan to translate goals into local programs. These should be tailored to meet local needs and, collaboratively with the state department of education, evaluations should be planned to assess progress. Integration of health and other child care services must be intimately interwoven with educational efforts. I would be remiss if I didn't again emphasize that health and education are indivisible. Poor health inhibits good learning, and a poorly educated child inhibits good health. We have not yet attained a comprehensive child health care system, just as we do not have a universal child care system for young children. Continuity among such programs is essential, and Zigler has emphasized this well.53 A recent National Commission on the Role of the School and the Community in Improving Adolescent Health established jointly by the National Association of State Boards of Education and the American Medical Association is an example of collaborative activity which should be encouraged.54 Health services should be complemented by health education. We are only on the threshold of bringing these together with education more fully. What has become apparent is that educators, especially those in large city school systems, recognize that without well developed health and social services, their efforts are immeasurably more difficult. Support school-based management with community participation. The governors should take cognizance of the disenchantment of teachers and administrators with what is perceived as insensitive bureaucracy in school governance. This takes the form of an emphasis on school-based management in which administrators, teachers, and students play a much more significant role in determining school policies and operations. Bull. N.Y. Acad. Med.
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We know from studies such as those of Rutter in England55 that student performance and behavior improve with school characteristics which apply sound social and cognitive learning principles. These characteristics are easier to define than to implement, but we know them well: Ample use of rewards, praise and appreciation, a pleasant and comfortable environment, opportunities for students to take responsibility and to participate in the running of their school, an appropriate emphasis on academic matters, positive teacher models, good classroom management, and effective school staff organization. But I hasten to add that involvement of teachers, administrators, and students is not enough. If Head Start has taught us anything, it is that community participation is the key to local commitment which will sustain efforts at improvement. It is clear that governors have been moving in this direction. In several states where local community participation has been eroded, neglected, or corrupted, state departments of education have moved in-in the public interest-and are attempting to restore a more genuine representation and participation at the local level. Kentucky and New Jersey are examples of different approaches to a distribution of resources and control. We need a more creative tension between the state and local efforts. While the state officials may be perceived as intrusive, without some public accountability local school programs may drift. An important corollary, again drawn from the Head Start experience, is that state officials should have confidence that if the local community is truly represented in school governance, the efforts to improve the lives of children and families will become increasingly effective. We must have confidence that all communities have the capacity to improve their schools. The corollary is that such efforts should not await a "charismatic leader." Again I draw on our Head Start experience in which we initiated 2,700 programs across the United States in one summer. If we were to await the charismatic figures for each of these we still would be waiting. It is impressive as one travels about the country that one finds so much talent. Our task is to provide the support systems to catalyze their efforts. Provide technical assistance from state departments of education in collaboration with universities. While I don't want to sound anti-intellectual by suggesting we don't need new knowledge-for we always do-my main thesis is that we have ample demonstrations which provide models for successful outcomes. Zigler has outlined what the school of the 21st century should look like; Gardner has written of the generic ingredients of successful Vol. 68, No. 1, January-February 1992
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curricula for teaching literacy, numeracy, and critical thinking; and Comer and others have demonstrated how one develops effective compacts among citizens, parents, teachers, and administrators for an integrated, effective program at the local level. I don't dwell on curriculum or improving the quality of teaching, for these have been effectively upgraded in many communities, but tailoring these efforts must be local. While such technical assistance seems like a vast challenge, much expertise exists in the nation. Collaborative efforts with the universities could enhance the capacity of the departments of education. Indeed, many demonstrations of university involvement in local school programs are on record. We need to develop a multiplier effect from the many successful demonstrations. We must demonstrate a commitment to a redistribution of resources. This surely will be required if we are to improve the schools in areas of concentrated poverty -often characterized by minority group status. The patterns of financing for the schools established decades ago are no longer functional for meeting the needs of our children at greatest risk. We can no longer afford to sweep the problems of one fourth of our children under the rug. At a recent annual meeting of the Children's Defense Fund, Marian Wright Edelman said that Congress, the states, and local communities must rewrite the options of opportunity for all our children, but especially for our poor children. We must be willing to write the checks that guarantee poor children a real chance of success from the moment they are conceived until the moment they receive as much education as they can absorb. Only then will the tragedy of children deprived from birth of a dignified life be banished forever from this land.56 Some efforts are already under way to arrive at these adjustments in some states and we already recognize the political hazards involved as more affluent communities view these efforts as depriving them of resources. Leadership will be required to generate the political will. It is also appropriate to note that this may provide a realistic role for the federal government, since its investment in elementary education is largely through the Elementary and Secondary Education Act designed to improve school programs for lowincome populations. Involve the private sector for continued support. The leaders of corporate America recognize that rebuilding our competitive position depends heavily on the extent to which we educate our children effectively. Compacts with industry can do much to complement the efforts of the schools. Also, much of the political will at the national, state, and local level of the schools depends on leadership from the private sector. Bull. N.Y. Acad. Med.
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CONCLUSION
The national consensus that we are at a critical period in education suggests urgency in developing strategies for reform. Fortunately, we have come through a period of moving toward upgrading the status of teachers, the development of curricula with sounder approaches to enhancing learning, and numerous successful demonstration programs which provide models for enhancing effectiveness. These models tend to be comprehensive, bringing together educational, social, and health services with school-based management and community participation and commitment. What seems essential now is the transformation of these successful programs into widespread social and institutional change. Building on 25 years of Head Start experience we have learned that local, community-based governance can be effective in meeting the needs of children and families. What is proposed, therefore, is not a categorical approach to school reform, but rather a process of state-local community relationships which may serve to engineer the changes on a larger scale. We need to act boldly, for we cannot afford to muddle through. REFERENCES 1. Wilson, W.J.: The Truly Disadvantaged. Chicago, University of Chicago Press, 1987. 2. Ellwood, D.T.: Poor Support: Poverty in the American Family. New York, Basic Books, 1988. 3. National Center for Children in Poverty: Five Million Children: A Statistical Profile of our Poorest Young Citizens. 1990. 4. Reed S. and Sauter, R.C. Children of Poverty: The status of 12 million young americans. Phi Delta Kappan: June 1990. 5. National Commission on the Role of the School and the Community In Improving Adolescent Health: Code Blue: Uniting for Healthier Youth. Alexandria, VA, National Association of State Boards of Education, 1990, p. 6. 6. Klerman, L.V.: Alive and Well? A Research and Policy Review of Health Programs for Poor Young Children. New York, National Center for Children in Poverty, 1991. 7. Bane, M.J. and Ellwood, D.T.: One fifth of the nation's children: why are they poor? Science 245:1047-53, 1989.
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8. US House of Representatives: US Children and Their Families: Current Conditions and Recent Trends. Washington, D.C., Govt. Print. Off., 1989. 9. US Bureau of the Census: Money, Income and Poverty Status in the US, 1989. Current Population Reports, Series P-60, no 168. Washington, D.C., Govt. Print. Off., 1990. 10. Klerman, L.V., op cit. 11. Reed, S. andSauter, R.C., opcit. 12. Klerman, L.V., op cit. 13. Klerman, L.V., op cit. 14. Both, D.R. and Garduque, L.: 1989. Social Policy for Children and Families: Creating an Agenda. A Review of Selected Papers. Washington, D.C., Nat. Acad. Press, 1989. 15. National Commission on Excellence in Education: A Nation at Risk. Washington, D.C., Govt. Print. Off., 1983. 16. Committee for Economic Development: Investing in Our Children. New York, Committee for Economic Development, 1985. 17. National Governors Assn: Time for Results: The Governors' 1991 Report on
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Education. Washington, D.C., Nat. Governors Assn., 1986. 18. Carnegie Forum on Education and the Economy, Task Force on Teaching as a Profession: A Nation Prepared: Teachers for the 21st Century. New York, Carnegie Forum on Education and the Economy, 1986. 19. Committee for Economic Development, Research and Policy Committee: Children in Need: Investment Strategies for the Educationally Disadvantaged. New York, Committee for Economic Development, 1987. 20. Institute for Educational Leadership: Dropouts in America: Enough is Known for Action. Washington, D.C., Institute for Educational Leadership, 1987. 21. Carnegie Council on Adolescent Development: Turning Points: Preparing American Youth for the 21st Century. New York, Carnegie Corporation of New York, 1989. 22. Carnegie Foundation for the Advancement of Teaching: The Condition of Teaching: A State-by-State Analysis. Lawrenceville, NJ, Princeton University Press, 1990. 23. National Commission on the Role of the School and the Community in Improving Adolescent Health, op cit. 24. Committee on Economic Development, op cit. 25. Task Force on Education: Educating America: State Strategies for Achieving the National Educational Goals. A Report. Washington, D.C., National Governors Assn., 1990. 26. New York Times. April 20, 1991. 27. Chubb, J.E. and Moe, T.M.: Politics, Markets and America's Schools. Washington, D.C., Brookings Institute, 1990. 28. Conel, J.L.: The Brain Structure of the Newborn Infant and Consideration of the Senile Brain. In: Association for Research in Nervous and Mental Disease, Vol. 19: The Inter-relationship of Mind and Body. Baltimore, Williams & Wilkins, 1939. 29. Bithoney, W.G.: Failure to Thrive. In:
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