







































Education, Society and Human Studies 
ISSN 2690-3679 (Print) ISSN 2690-3687 (Online) 

Vol. 1, No. 1, 2020 
www.scholink.org/ojs/index.php/eshs 

43 

Original Paper 

Education Policy: Addressing Racial Health Disparities in 

Educational Contexts 
Beth D. Williams-Breault1* 

1 Division of Social Sciences, College of Liberal Arts and Sciences, Lesley University, Cambridge, 

Massachusetts, United States of America 
* Beth D. Williams-Breault, Division of Social Sciences, College of Liberal Arts and Sciences, Lesley 

University, Cambridge, Massachusetts, United States of America 

 

Received: April 28, 2020          Accepted: May 5, 2020          Online Published: May 9, 2020 

doi:10.22158/eshs.v1n1p43                       URL: http://dx.doi.org/10.22158/eshs.v1n1p43 

 

Abstract 

Race, ethnicity, and Socioeconomic Status (SES) influence physical and mental health throughout the 

life course. Institutional and interpersonal discrimination is particularly detrimental, especially for 

children, and is associated with poor health outcomes. One of the most important determinants of 

long-term health is lifelong educational attainment. Center-based Early Childhood Education (ECE) 

and School-Based Health Centers (SBHCs) can help overcome educational obstacles and increase 

medical services in disadvantaged populations while fostering health equity. Educators involved in 

ECE programs and SBHCs for poor and minority youth must be involved in the policy making process 

in order to ensure that educational quality is considered essential to the long-term effects of health 

equity.  

Keywords 

race, ethnicity, socioeconomic status, health, equity, early childhood education, school-based health 

centers 

 
1. Introduction 

Racially and ethnically stigmatized people experience higher rates of illness, impairment, and death 

than the average society in the U.S. and globally (Assari, 2018; Phelan, Link, & Tehranifar, 2010; 

Williams & Anderson, 2016). Across multiple health outcomes, these disparities are seen in early onset 

of illnesses, severe diseases, and poor quality of care for minorities (Williams & Anderson, 2016). 

Socioeconomic Status (SES) is one of the most robust determinants of variations in health outcomes in 

almost every society throughout the world (Assari, Nikahd, Malekahmadi, Lankarani, & Zamanian, 



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2017; WHO Health Commission, 2008; Williams & Anderson, 2016). Understanding the complex ways 

in which race, ethnicity, and SES influence health outcomes is a critical task in addressing disparities 

across the socioeconomic spectrum (Assari, Nikahd, Malekahmadi, Lankarani, & Zamanian, 2017; 

Williams & Anderson, 2016). 

The categorization of social groups into races has historically reflected oppression, exploitation, and 

social inequality (Assari, 2018; Williams & Anderson, 2016). The identification of specific racial 

categories has been driven by historical circumstances and social and political factors. We consider 

“race” as primarily a social category that encompasses what is commonly referred to as ethnicity - 

common geographic origins, ancestry, family patterns, cultural norms and traditions, and the social 

history of specific groups (Williams & Anderson, 2016). 

 

2. Race, SES, and Health Outcomes 

SES is a complex and multi-dimensional concept that includes economic resources and power that can 

influence health at different times throughout the life course (Braveman et al., 2005; Williams & 

Anderson, 2016). According to the 2014 U.S. Census Bureau, for every dollar of wealth that Whites 

have, Asian households have 83 cents while Blacks have 6 cents and Hispanic/Latinos have 7 cents 

(Ryan & Siebens, 2012). Race and SES reflect distinct processes of stratification that can affect health 

outcomes (Williams & Anderson, 2016). However, income can diminish racial differences in economic 

status in some social contexts. 

Race matters for health after SES is considered. In addition to being influenced by current SES, health 

is also affected by exposure to adversity throughout the life-course. Early life adversity, such as poverty, 

abuse, and traumatic stress, vary by race and SES, and has been shown to influence multiple indicators 

of physical and mental health later in life, including cardiovascular, metabolic and immune function 

(Williams & Anderson, 2016; Shonkoff, Boyce & McEwen, 2009). Race matters to health disparities 

due to the lack of equity of SES indicators across racial groups. Compared to Whites, Blacks and 

Hispanic/Latinos receive less income at the same education levels, have less wealth at equivalent 

income levels, and have less purchasing power due to higher costs of goods and services in the 

residential environments where they are disproportionately located (Massey, 1990; Williams, 

Mohammed, Leavell, & Collins, 2010). 

Racism is one of the most critical distinctive social exposures experienced by racial minorities. 

Discrimination across both institutional and interpersonal levels remains ubiquitous in contemporary 

societies (Pager & Shepherd, 2008; Quillian, 2006; Williams & Anderson, 2016). Residential 

segregation by race, an example of an institutional racism, has created racial differences in education 

and employment opportunities which produces racial differences in SES (Massey, 1990; Williams & 

Anderson, 2016). Self-reported experiences of discrimination have been associated with a broad range 

of disease outcomes, preclinical indicators of disease and health risk behaviors (Lewis, Cogburn, & 



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Williams, 2015; Williams & Anderson, 2016). As with other forms of early life adversity, 

discrimination is particularly detrimental to children, with associated poor health outcomes reported in 

childhood and adolescence increasingly documented internationally (Byrd & Mirken, 2011; Priest et al., 

2013; Williams & Anderson, 2016). Institutional and cultural racism can also harm health through 

stigma, stereotypes, and prejudice all of which can contribute to stunted socioeconomic mobility and 

reduced access to a broad range of societal resources and opportunities required for health (Williams & 

Mohammed, 2013). 

Racial minorities have a higher risk of exposure to a broad range of psychosocial stressors as well. 

Institutional discrimination and socioeconomic disadvantages lead to the overrepresentation of 

minorities in toxic residential and occupational environments that can lead to risks of exposure to major 

hardships, conflicts and disruptions such as crime, violence, material deprivation, loss of loved ones, 

recurrent financial strain, relationship conflicts, unemployment and underemployment (Pager & 

Shepherd, 2008; Williams & Anderson, 2016). Children from low-income and racial or ethnic minority 

populations in the U.S. are less likely to have a conventional source of medical care and more likely to 

develop chronic health problems than are more-affluent and non-Hispanic white children (Knopf et al., 

2016).  

 

3. Educational Interventions 

In the U.S., inequities by race, ethnicity, and income in key health outcomes and educational 

achievement are well documented (Bloom, Cohen, & Freeman, 2012; Hahn et al., 2016). Lifelong 

educational attainment is one of the most important determinants of long-term health (WHO, 2008; 

Hahn et al., 2016). Incomplete or poor-quality education can jeopardize a child's prospects for health 

and well-being. Inequities in health by race and SES highlight the urgent need for a renewed research 

focus of identifying interventions at multiple societal levels that will be effective in reducing and 

ultimately eliminating racial inequities in health (Williams & Anderson, 2016).  

Center-based Early Childhood Education (ECE) can potentially foster the larger public health goal of 

health equity, with a focus on low-income and racial and ethnic minority populations in the United 

States (Hahn et al., 2016). The term health equity refers to a widespread, systematic, achievable 

equality in health and in the major social determinants of health that benefit all social divisions of a 

population (Arcaya, M. C., Arcaya, A. L., & Subramanian, 2015; Hahn et al., 2016). 

ECE programs are defined as programs designed to improve the cognitive or social development of 3- 

and 4-year-old children prior to kindergarten enrollment (Goerge et al., 2015; Hahn et al., 2016). 

Programs include an educational component that addresses one or more of the following learning 

objectives: literacy, numeracy, cognitive development, socio-emotional development, and motor skills. 

Eligible programs may offer additional components including recreation, meals, health care, parental 

supports, and social services. Some programs enroll children younger than 3 years (Hahn et al., 2016). 



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State and district programs and the federal Head Start program are publicly financed, whereas model 

programs often have been implemented in well-funded research projects, closely monitored for fidelity 

of implementation, and staffed by highly trained staff (Goerge et al., 2015; Hahn et al., 2016).  

ECE programs can affect education and health by several interrelated intermediate determinants. The 

programs can increase motivation and readiness of children for formal schooling by engaging with 

caring teachers and other same-age children. Engagement with teachers and peers promotes social 

behaviors that facilitate learning and enhance the long-term life skill of positive social interaction 

(Goerge et al., 2015; Hahn et al., 2016). Teacher contact also increases early identification of social, 

health, and cognitive challenges of individual children and enables early referral for intervention when 

needed. Interactions among teachers and ECE parents strengthen parents' capacities, including their 

ability to reinforce the education and socialization of their children (Goerge et al., 2015; Hahn et al., 

2016).  

By enhancing social and educational skills before children enter formal schooling, ECE programs 

strengthen the foundation for ongoing learning, with substantial long-term health benefits. ECE 

programs are critical for low-income and minority children who have not been exposed to the learning 

environments generally more available to higher-income families (Hahn et al., 2016; Yen & Lee, 2019). 

High-quality ECE programs that increase participation of low-income and racial and ethnic minority 

children are expected to improve long-term educational and health outcomes and reduce disparities 

(Goerge et al., 2015; Hahn et al., 2016; Yen & Lee, 2019). 

Children from low-income and racial or ethnic minority populations in the U.S. are more often 

chronically stressed, tired, and hungry, and more likely to have impaired vision and hearing—obstacles 

to lifetime educational achievement and predictors of adult morbidity and premature mortality (Knopf 

et al., 2016). School-Based Health Centers (SBHCs) can help overcome educational obstacles and 

increase medical services in disadvantaged populations (Love, Schlitt, Soleimanpour, Panchal, & Behr, 

2019; Knopf et al., 2016). SBHCs improve educational and health-related outcomes in disadvantaged 

students and they can be effective in advancing health equity (Knopf et al., 2016; Ran et al., 2016). 

Health outcomes and educational achievement are related to each other in several ways. Health 

problems (e.g., vision and oral health problems, asthma, teen pregnancy, malnutrition, obesity, chronic 

stress, and inattention and hyperactivity disorders) and risk-taking behavior (e.g., aggression and 

violence, unsafe sexual activity, unhealthy eating, physical inactivity, and substance use) are associated 

with low scholastic performance (Basch, 2010; Bradley, & Greene, 2013; Knopf et al., 2016). Low 

academic achievement is positively associated with risk-taking behavior, compromised health status, 

and reduced longevity (Braveman, Egerter, & Williams, 2011; Fiscella & Kitzman, 2009). Children 

from low-income and racial or ethnic minority populations in the U.S. are more likely to develop 

chronic health problems than are more-affluent and non-Hispanic white children and less likely to have 

a usual source of medical care (Bloom, Cohen, & Freeman, 2012; Knopf et al., 2016) SBHCs are 



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defined as clinics that provide health services to students in pre-Kindergarten through Grade 12. 

Services may be offered onsite (i.e., school-based centers) or offsite (i.e., school-linked centers) and are 

often established in schools that serve predominantly low-income communities (Knopf et al., 2016; 

Riley, Laurie, Plegue, & Richardson, 2016).  

SBHCs can improve educational and health outcomes through several pathways. Specifically, increased 

access to and satisfaction with health-related services are expected to increase receipt of recommended 

services that lead to early detection and treatment or prevention of disease (Knopf et al., 2016). 

Increases are expected in school achievement and the proportion of students with a usual place of care, 

along with reductions in illness, injury, and healthcare overuse (Knopf et al., 2016). When SBHCs offer 

health education and counseling, reductions in risk behavior are also expected. Overall, SBHCs are 

expected to improve the health prospects of low-income and racial and ethnic minority students 

(Bersamin et al., 2016; Knopf et al., 2016). 

Substantial educational benefits associated with SBHCs include reductions in rates of school 

suspension or high school non-completion, and increases in grade point averages and grade promotion 

(Bersamin et al., 2016; Knopf et al., 2016). Healthcare utilization improves, including substantial 

increases in recommended immunizations and other preventive services, and a small increase in the 

proportion of students who reported a regular source of health care (Bersamin et al., 2016; Knopf et al., 

2016). Regarding sexual and reproductive behaviors associated with SBHCs, contraceptive use among 

females increases, childbirth decreases, and prenatal care improves (Bersamin et al., 2016; Knopf et al., 

2016). 

SBHCs are effective in improving an array of educational and health-related outcomes. Increased 

effectiveness is associated with extended hours of availability and increased range of offered services 

(Knopf et al., 2016). Because SBHCs aim to meet the needs of disadvantaged populations, address the 

health-related obstacles to educational achievement, and address the cultural, financial, and privacy- 

and transportation-related barriers to clinical, preventive, and healthcare services, they have the 

potential to promote social mobility and improve health equity (Duncan & Murnane, 2011; Knopf et al., 

2016). 

Increased parental work time and reduced child care, transportation needs, time, and costs have been 

identified as additional benefits of SBHCs (Hutchinson, Carton, Broussard, Brown, & Chrestman, 2012; 

Knopf et al., 2016; Tai & Bame, 2011). Since many SBHCs are open to others in the community, 

improvements in health (and education) in the broader community are also expected. SBHCs provide 

more-sensitive care such as reproductive health and mental health than may be available in other 

settings,and improve quality of care and patient satisfaction with and acceptability of care (Keeton, 

Soleimanpour, & Brindis, 2012; Klein et al., 2007; Knopf et al., 2016).  

Additionally, benefit is anticipated to extend beyond SBHC users, as many SBHCs offer health 

education and promotion activities to the entire student body, and non-users may adopt some of the 



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promoted health behaviors such as abstaining from drugs and alcohol (Knopf et al., 2016; McNall, 

Lichty, & Mavis, 2010). SBHCs also have been reported to improve student academic expectations, 

safety and respect, and school engagement; to increase adolescents’ responsibility for and awareness of 

their health; and to strengthen connections between community and school (Keeton, Soleimanpour, & 

Brindis, 2012; Knopf et al., 2016; Strolin-Goltzman, 2010). Due to improved vaccination uptake, 

reduced transmission of vaccine-preventable diseases is also expected. Additionally, most SBHCs help 

children and families enroll in Medicaid and the State Children’s Health Insurance Program (Knopf et 

al., 2016). 

 

4. Education Policy: Massachusetts 

Political support is needed to utilize the best available research to reduce social inequalities in health. 

Interventions should focus on improving the health of disadvantaged groups more rapidly than the rest 

of the population so that progress can be made in eliminating inequalities. Many education policies that 

promise the greatest benefit in improving population health are sometimes likely to actually widen 

disparities (Mechanic, 2002; Williams & Anderson, 2016). 

In Massachusetts, state aid for education is determined by a calculation outlined in Chapter 70 of the 

Massachusetts General Law. Collectively referred to as “Chapter 70”, the statute includes a formula for 

determining an “adequate” amount of money each district must spend on education, called the 

foundation budget, and the “equitable” division of state funds to assist each district in meeting their 

mandated spending level (Britt & Hall, 2009). Chapter 70 is designed to provide “adequate and 

equitable funding for public schools in the Commonwealth”. This funding has become the most 

significant and only growing source of local aid to Massachusetts cities and towns and is heavily 

scrutinized by a variety of stakeholders due to a perceived lack of transparency (Britt & Hall, 2009; 

DeCosta-Klipa, 2019). 

Massachusetts had historically relied on local property taxes to finance education, which created 

significant inequities in school funding between wealthy and poorer communities. Growing concerns 

about the disparities in public education across the Commonwealth coincided with the State Supreme 

Court case McDuffy v. Secretary of the Executive Office of Education, prompting legislators to enact 

the Education Reform Act in 1993 (Britt & Hall, 2009). The Act included provisions intended to reform 

public education in Massachusetts to meet the state’s Constitutional mandate to provide a quality public 

education to all of its citizens (Britt & Hall, 2009; DeCosta-Klipa, 2019). 

Crucial to these reforms was a dramatic revision of the way public schools were financed. In order to 

provide equal access to quality public education across the Commonwealth, the state first needed to 

determine what constituted a quality education by identifying the minimum level of spending required 

to meet that standard. (Britt & Hall, 2009; DeCosta-Klipa, 2019). Additionally, in recognition that not 

all districts could meet an expanded financial obligation on their own, the state needed to provide 



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additional funding to those communities. These premises form the basis of what is known today as 

Chapter 70 (Britt & Hall, 2009). 

The program calculates a “foundation budget” for each school district—based on enrollment, student 

demographics (including grade levels, low-income students, and English language learners), inflation, 

and local wage levels—to determine the minimum funding needed to provide an adequate education to 

each student (DeCosta-Klipa, 2019). Every school district then gets a mix of local and state funding. 

Based on each municipality’s wealth (using property values and personal income), the formula 

establishes a goal for how much each city or town should be contributing to its foundation budget. All 

districts are guaranteed some minimum funding from the state (DeCosta-Klipa, 2019). 

Although the 1993 reform bill did help improve the achievement gap in Massachusetts and close some 

of the inequalities that existed at the time, there are still wide disparities in school funding between rich 

and poor communities. Those disparities have led cities like Brockton and Worcester—in the wake of 

teacher layoffs and increasing class sizes—to consider bringing new lawsuits challenging the Chapter 

70 formula (DeCosta-Klipa, 2019).  

In 2015, state lawmakers established the Foundation Budget Review Commission to review the 

Chapter 70 formula—and its shortfalls. In a report, the commission found that some of the formula’s 

assumptions can become outdated, resulting in underfunding. The commission found that an 

achievement gap persisted for low-income students and English Language Learners (ELL). The report 

stated that many school districts, particularly those with high concentrations of low-income and ELL 

students, faced “unique costs” and needed additional funding to close the achievement gaps for those 

group (DeCosta-Klipa, 2019). 

Along with a number of additional tweaks to the formula, the PROMISE Act intends take the 2015 

commission’s recommendations and phase them into law. This bill would increase the base rate of 

funding schools get for low-income and ELL students by 50 percent to 100 percent per student, 

depending on the wealth of the district. The legislation would create a data advisory committee made 

up of education experts and officials focused on streamlining and strengthening school-level staffing, 

spending, and student demographics “to better inform future policy decisions”. Gov. Charlie Baker was 

expected to introduce legislation to amend the Chapter 70 formula in 2018 and is optimistic that 

lawmakers will get something passed (DeCosta-Klipa, 2019). 

 

5. Discussion 

In 2015, The National Network of State Teachers of the Year released an important new report, 

“Engaged: Educators and the Policy Process”, which applauded the ways in which teachers are 

involved in policy decisions today. The number of opportunities through which teachers can engage in 

education policy has grown significantly in recent years. In addition to the National Education 

Association and the American Federation of Teachers, which have represented teachers in policy 



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conversations for decades, the National Network of State Teachers of the Year, Teach Plus, Hope Street 

Group, America Achieves, Educators 4 Excellence, Leadership for Educational Equity, and Teach For 

America have launched initiatives to train current or former teachers in policy analysis and content and 

to provide them with opportunities to use their voices to influence policy (Brown, 2015). By bringing 

teachers into the conversation, programs and processes improve the likelihood that policy will be 

well-designed, well-received, and well-implemented in the classroom. By providing teachers with new 

challenges and new opportunities, new professional growth opportunities for teachers are created, 

helping them to receive recognition for their contributions and to stay energized by their profession 

(Brown, 2015). 

There are some important lessons that policymakers should take from the National Network of State 

Teachers of the Year report. First, policymakers should be selective about the perspectives they seek. 

One great aspect of the network of teachers in policy conversations is that all the teachers involved 

have demonstrated excellence in their field. Second, trust is essential and relationships take time. 

Policymakers who seek teachers’ input after policies have been formulated are likely to be less 

well-received than those who put in the time on the front end to cultivate a bond. Third, policy can be 

complex, and teachers need training to understand how policy shapes their classrooms. Simply asking 

teachers for their perspective without a strong foundation of knowledge about the frameworks of local, 

state and federal law is not always going to result in a productive conversation (Brown, 2015).  

Racism is an organized system of social stratification that combines with, and even transforms SES to 

influence health. Action is critically required to address how the health of socially disadvantaged 

groups is determined by exposures to risks and resources linked to living and working conditions, and 

how intervening in these contexts can lead to improvements in health. 

Educators involved in ECE programs and SBHCs for poor and minority youth must speak with policy 

makers to address educational quality as an important modifier of the long-term effects of health equity. 

Since poor and minority children are likely to live in poor neighborhoods, they are also more likely to 

attend lower-quality schools. ECE programs and SBHCs improve both educational and health 

outcomes and must be supported by bills such as the PROMISE Act. Since ECE programs and SBHCs 

are commonly implemented in low-income communities and communities with high proportions of 

racial and ethnic minority populations, this source of student health care may be a prominent means of 

advancing health equity. 

 

 

 

 

 

 



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