Chronic absenteeism –– defined as missing 10% or more of school days within an academic year –– is a crisis plaguing Baltimore schools.
The Baltimore Sun reported that in 2021-2022, 58% of Baltimore City’s public school students missed at least 18 days of school. Despite a slight decrease since the pandemic, current rates of absenteeism still hover around 45%, and schools with a large population of low-income students are disproportionally affected.
The implications are severe. A study of Baltimore City Public Schools found that sixth-grade chronic absenteeism was the strongest predictor of not graduating high school, beyond test scores or other academic indicators. Chronic absenteeism has also been linked to poor long-term health outcomes, including a higher risk for depression. The message is clear: If we fail to address this issue, a significant portion of our youth may face worse outcomes for both their education and their health.
Efforts by individual schools to combat absenteeism, while commendable, have proven insufficient. The persistence of high absenteeism rates calls for a systemic approach. As a former teacher and current medical student, I witnessed firsthand the extent of absenteeism during the pandemic. Many of my friends who are still teaching have told me how little the situation has improved.
To tackle chronic absenteeism, we need to broaden the conversation and include new allies, particularly health care providers, who can help address some of the root causes.
Just this past year, the White House released a statement saying chronic absenteeism was an “all-hands-on-deck” situation, featuring pediatricians as key players. Some advocates even suggest treating chronic absenteeism as a “vital sign,” akin to those measured at the doctor’s, due to its strong correlation with both health and educational outcomes.
Chronic absenteeism often reflects deeper issues, such as adverse childhood events (ACEs), unmet health needs and socioeconomic disparities. Children grappling with ACEs are more likely to experience mental health challenges, which can lead to school avoidance. Chronic health conditions like asthma, eczema and diabetes can also directly cause frequent absences. Without proper medical care from school nurses and other health care providers, these chronic conditions impede a child’s ability to attend and engage in school.
While there are many factors that impact chronic absenteeism –– including disease prevalence and environmental stressors –– inadequate access to high-quality, preventive health care is one such barrier to school attendance that disproportionately affects children of color, further widening gaps in health and education.
Altogether, the data shows that chronic absenteeism is more than an educational issue, it’s a public health crisis.
Many pediatricians already inquire about school during patient visits, but they may not pick up on frequent absences. Consider instead the successful initiative in Washington, D.C., where the District of Columbia Public Schools partnered with Children’s National Hospital to form the Collaborative for Attendance Resources in Education and Health (CARE-H). With parental consent, attendance data was securely shared between schools and pediatricians. Using this, the program identified acute illness, asthma and mental health challenges as key drivers of absenteeism. In its three years, CARE-H was able to provide over 160 referrals for medical and social support, underscoring the effectiveness of a joint initiative in addressing absenteeism’s root causes.
Implementing a similar attendance data-sharing program between schools and pediatricians in Baltimore could connect students and families to important health resources and reduce barriers to attendance.
Baltimore City has 19 school-based health centers (SBHCs) with established partnerships between health care providers and educators. At the Johns Hopkins Rales Health Center, an SBHC here in Baltimore, I’ve helped with several initiatives providing vision access, asthma prevention and healthy lifestyle strategies directly to students and their families. Supporting SBHCs and expanding initiatives like these that implement early interventions for chronic health conditions at our 19 SBHCs could significantly reduce absenteeism. In fact, data shows that SBHCs are associated with improved school attendance. Recent partnerships between Baltimore City Schools and local nursing schools further highlight the intersection between health and education.
These interventions — including data sharing between schools and health care providers and building upon SBHCs and other school health services like school nursing — recognize the overlap between health and education, and in doing so, provide critical and currently missing support for students and their families. We call on community leaders to help implement these multidisciplinary interventions. Let’s ensure that every child in Baltimore can succeed academically and thrive physically and emotionally.
Connie Cai is a student at the Johns Hopkins University School of Medicine.
