In April, U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. turned the focus of his听听movement toward school food,听听鈥渕ajor, dramatic changes鈥� in school nutrition programs, which serve nearly听听across the country each year.

鈥淪chool lunch programs have deteriorated where about 70% of the food that our children eat is ultraprocessed food, which is killing them,鈥� Kennedy . 鈥淲e need to stop poisoning our kids and making sure that Americans are once again the healthiest kids on the planet.鈥�

The federal government is working to develop a of ultraprocessed foods, but they are to be industrially produced, ready-to-eat foods that contain high levels of sugar, salt, or additives, such as chips, soft drinks, and frozen meals.

Global consumption of ultraprocessed foods has in recent years. published by the Centers for Disease Control and Prevention in August, youth ages 18 and under consumed more than 60% of their daily calories from ultraprocessed foods.

Now, there is a associating ultraprocessed foods with negative health outcomes. In November, a found evidence that increased consumption of ultraprocessed food is a 鈥渒ey driver鈥� of escalating rates of diet-related chronic disease. The series authors to reduce the consumption of ultraprocessed foods, including by restricting ultraprocessed foods in school meals.

Federal efforts to of school meals have largely focused on implementing , which regulate nutrients like added sugars and sodium. However, these regulations don鈥檛 necessarily result in less ultraprocessed food 鈥� instead, manufacturers often to meet new thresholds. School nutrition programs, faced with tight budgets and limited staff capacity, often rely on ultraprocessed products like frozen pizzas, packaged sandwiches, and packaged breakfast pastries.

As the federal government and other entities work to reduce the consumption of ultraprocessed food, what will it actually take for schools to stop serving them?

鈥淥ur government right now has 鈥� more of a 鈥榯akeaway鈥� mentality,鈥� said Jayme Robertson, school nutrition director for and schools, regarding federal school nutrition standards. 鈥淚f you change that and instead focus on more fresh, more local, more raw ingredients, more scratch cooking, then that鈥檚 where the real impact is going to happen.鈥�

Robertson and other believe a paradigm shift is needed for schools to reduce ultraprocessed food and implement more scratch cooking, which involves preparing meals with whole, raw, or minimally processed ingredients. While data on the prevalence of scratch cooking is limited, the latest found that most school nutrition programs make less than 25% of meals from scratch.

鈥淲e need to stop penny pinching and start looking at the long-term outcomes of what serving less processed food in schools would produce. And we need to make sure our school districts have the resources they need to actually do this,鈥� said Mara Fleishman, CEO of the . 鈥淚f we want Americans to stop eating ultraprocessed food, let鈥檚 start in kindergarten.鈥�

The technical challenges of scratch cooking

Before scratch cooking can begin, school nutrition programs have to secure necessary equipment, hire staff with culinary expertise, purchase ingredients, and plan menus that meet federal requirements.

Equipment

鈥淲hen you go into schools that don鈥檛 have running water, don鈥檛 tell me to scratch cook,鈥� said Dr. Katie Wilson, executive director of the .

Many school nutrition programs cannot scratch cook due to limited or outdated kitchen facilities that prevent the storage, processing, or cooking of whole ingredients 鈥� such as a lack of coolers or freezers to store fresh ingredients.

Buying new equipment or renovating facilities can pose a major cost. School nutrition programs operate financially independently of school districts as self-sustaining, nonprofit enterprises. The roughly $4.60 per lunch provided by must be used to cover the cost of food, supplies, labor, equipment, and overhead costs, often leaving little room in the budget for large capital investments.

Even if a district can afford the upgrades needed to scratch cook, there may be additional hurdles to installing and using that equipment, particularly in older school buildings. For example, Wilson recalled speaking to a school nutrition director who spent $500,000 on equipment that hasn鈥檛 been used yet because there isn鈥檛 enough power in the school building to plug it in.

Staffing

School nutrition programs often face听听staff. In a听听of school nutrition directors conducted by the School Nutrition Association (SNA) in 2024, nearly 89% of respondents reported challenges with staff shortages, and the overall vacancy rate was 8.7%.

To scratch cook, school nutrition programs not only need sufficient staffing levels 鈥� they also need to hire staff with the skills necessary to cook using whole ingredients, including knowledge of specific culinary skills, food safety, and equipment use. According to Wilson, the majority of school nutrition employees are not paid to attend training, making it difficult for them to build the skills needed to scratch cook.

鈥淚t鈥檚 about valuing food 鈥� valuing what they contribute to the school day and to the students鈥� life. We don鈥檛 value them, and that鈥檚 why they鈥檙e many times the lowest paid,鈥� said Wilson of school nutrition professionals compared to other school employees.

Ingredients

School nutrition programs often need to purchase more fresh, whole ingredients to scratch cook, which may involve developing new vendor relationships and executing new contracts. But this is not as simple as finding a local farmer to purchase meat and vegetables from, according to school nutrition leaders.

As recipients of federal funding, school nutrition departments must adhere to a variety of , which dictate what procurement techniques can be used based on the purchase amount.

According to Wilson, varying interpretations of federal procurement rules are one of the biggest challenges facing school food purchasing. This challenge is further compounded by the fact that, if a state or locality has different purchasing thresholds than the federal government, the more restrictive threshold must be followed.

鈥淚f everybody would get on the same page and just follow the federal standard rules, we could work at changing some of those federal rules to make them better for fresh, whole food,鈥� she said.

Menu plans

The U.S. Department of Agriculture (USDA) regulates the nutritional quality of school meals through , which dictate each required component of the meal 鈥� such as how many cups of different types of vegetables must be included 鈥� and place limits on calories, saturated fat, added sugar, and sodium.

Scratch cooking involves preparing recipes that rely on whole ingredients but still adhere to these requirements, which takes more planning and results in greater variation than purchasing pre-made, ultraprocessed items that already meet all requirements. If schools deviate from the meal pattern, they risk not receiving federal reimbursement.

鈥淲e have forced, particularly small districts 鈥� where they don鈥檛 have the money or the team to hire chefs or all these other people to help them with this 鈥� we鈥檝e forced them to buy pre-packaged, formulated food, because it guarantees they meet the meal pattern,鈥� said Wilson.

Wilson recalled that, during her time as a school nutrition director, scratch-made zucchini muffins were less than 0.1 ounces away from the required weight, disqualifying the muffins from counting as a meal component that day.

鈥淵ou can鈥檛 do scratch cooking if that鈥檚 what you鈥檙e under when it comes to the micromanagement of the meal pattern,鈥� she said.

The adaptive challenges of scratch cooking

Beyond the technical challenges facing scratch cooking, shifting away from ultraprocessed food and toward preparing meals from scratch requires change management. This presents a series of , or those related to shifting mindsets, values, and culture.

Through her work at the Chef Ann Foundation, which supports schools in implementing scratch cooking, Fleishman has seen that a strong commitment from school nutrition leaders is crucial to success 鈥� because scratch cooking isn鈥檛 easy.

鈥淚n many ways, it鈥檚 easier to pull a frozen chicken nugget out of the freezer,鈥� she said. 鈥淲hen you start building a scratch cook program, there is a lot of uplifting that has to be done. So you really need to be in it, you have to see the value of it, you have to believe in it, you have to be in it for the long term.鈥�

The Chef Ann Foundation 鈥渟ees the transition to scratch cooking as a continuum of gradual progress rather than an all-or-nothing approach,鈥� according to its , with a five-step continuum that ranges from ready-to-eat meals to scratch-made meals. 

Fleishman said that moving along this continuum takes time, and schools often have to start small and introduce new scratch-made menu items gradually as they secure new equipment.

As Yadkin County and Elkin City schools transitioned to scratch cooking over the last five years, Robertson said she has worked intentionally to build trust and buy-in with her school nutrition team. In her first year as school nutrition director, she worked in school kitchens to build relationships, learn about the speed-scratch approach, and understand equipment and staffing levels.

鈥淚t really made sense for me to use that first year to observe, to learn, to really immerse myself in how the program was operating, instead of coming in and just making drastic changes,鈥� said Robertson.

Using lessons from that experience, she then created a menu committee and a managers council to ensure 鈥渂oots on the ground鈥� voices informed the district鈥檚 approach to scratch cooking. She said this created a structured way to gather feedback and troubleshoot plans before they were implemented.

鈥淚t gave everybody a voice at the table, and it got everybody on the same page in terms of the direction we were moving,鈥� she said.

School nutrition staff then participated in professional development where they watched new scratch-made recipes be prepared, providing them with a visual, step-by-step explanation of how to cook each component. Just like cooking at home, Robertson said that as staff cooked new recipes repeatedly, their comfort level grew.

Fleishman echoed how important creating buy-in with school nutrition professionals is for the success of scratch cooking efforts.

鈥淚f you鈥檙e able to build a culture of professionalism and value within school food and help your team understand why cooking from scratch is so important and what the impact of their work will be, then you don鈥檛 necessarily get some of the pushback that you see,鈥� she said.

Then, once scratch-cooked items are available, there鈥檚 still work needed to shift students鈥� preferences away from the ultraprocessed foods they may be accustomed to eating. 

鈥淚t鈥檚 not like they鈥檙e serving packaged, processed french toast sticks, and then you put the scratch-cooked french toast casserole on the menu and everyone鈥檚 like, 鈥榊eah I like this so much better,鈥欌�� said Fleishman. 鈥淯ltraprocessed food is highly addictive. So there is a period of transition.鈥�

Marketing to students and families that explains what scratch cooking is, why the school nutrition program is doing it, and why scratch-made items are healthier can help encourage students to try new items.

For example, Robertson shares new recipes through newsletters and on social media, highlighting which ingredients are locally sourced and tagging farmers. She also uses taste tests with students to ensure scratch-made items are things they enjoy eating.

The financial equation

While there鈥檚 a common perception that scratch cooking is more expensive than serving processed food, according to Fleishman, it doesn鈥檛 necessarily have to cost more. Although equipment purchases can pose a major cost, when comparing a scratch-made item directly with a processed counterpart, the scratch-made item may be less expensive or cost the same, depending on what ingredients are used.

鈥淚n reality, it could cost more 鈥� you could buy all organic, regenerative ingredients. But it doesn鈥檛 have to. You can scratch cook within the federal reimbursement rate,鈥� said Fleishman, adding that it鈥檚 crucial for school nutrition directors to have strong financial management skills in order to manage a sustainable scratch cooking program.

For example, in Yadkin County and Elkin City schools, Robertson said it costs roughly $1.10 per serving of the pre-made spaghetti sauce the district previously purchased, and it now costs $0.95 per serving to prepare a scratch-made sauce. In an of four school districts that participated in the Chef Ann Foundation鈥檚 Get Schools Cooking program, the 鈥渙verall financial health鈥� of school food programs increased after transitioning to scratch cooking.

Robertson has also leveraged strategic menu planning to purchase a core set of ingredients and cut down on unnecessary inventory. For example, she now purchases raw ground beef as a base protein for multiple scratch-made items 鈥� including spaghetti, tacos, and hamburgers 鈥� replacing several processed items.

What鈥檚 needed to support more scratch cooking?

Robertson compares trying to implement scratch cooking in the current policy and regulatory environment as 鈥減utting together a Jenga puzzle and hoping it doesn鈥檛 fall.鈥�

鈥淵ou鈥檙e asking employees that you鈥檙e not paying hardly anything to, to see these regulations through and provide an enjoyable experience. I feel like it鈥檚 just becoming harder and harder. It鈥檚 almost like you鈥檙e being asked to do more with less every single year,鈥� she said.

As more schools work to reduce ultraprocessed foods in school meals and implement scratch cooking, experts point to a variety of possible solutions.

Higher school meal reimbursement rates

As the costs of and continue to rise, many school nutrition programs find it difficult to provide school meals within the per-meal , which is roughly $4.60 for each free school lunch and $2.46 for each free school breakfast, with lower reimbursements for reduced-price and paid meals.

鈥淚 do not feel like students thrive on mini powdered donuts 鈥� but I know the mini powdered donut is more cost-effective, and it takes me less labor in the morning, and I don鈥檛 have the money to put into it,鈥� said Robertson.

In the of school nutrition directors nationwide, nearly all respondents cited challenges with the cost of food (97.9%), labor (94.9%), and equipment (91.4%), and only 20.5% reported the reimbursement rate is sufficient to cover the cost of producing a meal.

Low reimbursement rates can also make it difficult for school nutrition programs to recruit and retain staff. This is particularly true in areas with a higher cost of living where other food service jobs may pay employees a higher wage, making it difficult for school nutrition programs to offer a competitive wage.

Introduced in Congress in October, the would permanently increase the federal reimbursement rate for school meals, adding an additional 45 cents for each lunch served and an additional 28 centers for each breakfast served.

鈥淗igh costs and insufficient funds are hampering efforts to expand scratch cooking and reduce added sugar and sodium in school meals,鈥� said SNA President Stephanie Dillard in a about the bill. 鈥淪chool meal programs desperately need increased reimbursements to invest in staff and training, upgrade kitchen equipment, and purchase more fresh and local produce.鈥�

Funding for school kitchen equipment

Because school nutrition programs operate financially independently, local school districts often aren鈥檛 able to fund equipment for school kitchens. This means state or federal investments are needed to ensure schools have the equipment needed to scratch cook.

In previous years, the USDA has offered , but funds can only be used to cover the cost of the equipment and not the corresponding increase in energy or other utilities needed to use it, which Wilson said poses a challenge.

At the state level, California has allocated from the state鈥檚 general fund to provide funding for infrastructure upgrades and equipment in school kitchens, along with staff training, with the goal of helping more schools offer scratch-made items.

Investments in the school nutrition workforce

Investments are also needed to better recruit and train culinary professionals to work in school nutrition programs, school nutrition leaders said.

鈥淯nless we are able to fundamentally look at developing the greater workforce in school food, then a lot of the work that we鈥檙e all doing is kind of pushing this boulder up a hill, and it might come back down,鈥� said Fleishman.

To help meet these workforce needs, the Chef Ann Foundation developed the nation鈥檚 first for scratch-cooked school meals, currently available in Colorado, Virginia, and California, with more states to come. The apprenticeship programs provide aspiring and beginning school food professionals with the skills needed to create and manage scratch-cook school meal programs.

Adopting universal free school meals

Serving free meals to all students in school meals 鈥� along with 鈥� providing school nutrition programs with more federal reimbursement funds and giving them a better opportunity to enhance the food they are serving, including through scratch cooking. 

Currently, 鈥� California, Colorado, Maine, Massachusetts, Michigan, Minnesota, New Mexico, New York, and Vermont 鈥� have passed permanent legislation that provides free school meals to all students. Dozens of other states, including North Carolina, have introduced bills that would do the same.

Funding for local food purchases

Given that scratch cooking requires school nutrition programs to use whole, raw, or minimally processed ingredients, funds to purchase local food for school meals can help offset the costs of scratch cooking while keeping school food spending in the local economy.

However, in March 2025, the USDA canceled $660 million for the . Started in 2021, the program provided funding to states to purchase local foods for use in schools, helping farmers sell more of their products to schools and expanding local and regional food markets.

Without this funding, schools face even greater , reducing the amount spent in the local agricultural economy and relying instead on large national wholesalers or distributors.

Looking ahead

Despite the challenges of implementing scratch cooking, Robertson said the shift to preparing more items from scratch has generated strong support from the local community, which has been fulfilling for her staff.

鈥淪taff members will get stopped in grocery stores, by parents or teachers, and they鈥檒l rave about a particular menu item they heard their child talk about,鈥� she said.

Robertson鈥檚 mom worked in public education, and she remembers a time when students enjoyed the food they were served in the school cafeteria. They would even ask for recipes. 

鈥淚鈥檓 not sure when that stopped, but that鈥檚 kind of my ultimate goal 鈥� to get back to that and build those relationships,鈥� she said.

This first appeared on and is republished here under a .

Before the pandemic helped fuel the growth of vaccine politicization across the country, less than 1% of Austin school district鈥檚 kindergarteners in the fall of 2019 failed to comply with the state鈥檚 vaccine reporting requirements.

Five years later, Austin ISD had some of the state鈥檚 highest number of kindergarteners who neglected those state requirements 鈥� about 1 in 5 kindergarteners had not proven they were fully vaccinated against measles and did not file an exemption.

A Texas Tribune analysis has found that this explosion of vaccine non-compliance has played out across many school districts in the state in recent years, helping to push Texas鈥� measles vaccine coverage to the lowest it鈥檚 been since at least 2011.

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鈥淲e definitely were on a better trajectory [before the pandemic],鈥� said Alana Bejarano, executive director of health services and nursing for the Austin school district, which reported a 23% delinquency rate for the measles vaccines among their kindergarteners.

鈥淚 don’t know that I can pinpoint the concrete answer, except [preschool and kindergarteners] were born at a time where everything kind of went off track and getting them back into that, you know, that’s been difficult.鈥�

The Tribune examined kindergarten measles vaccination compliance because it鈥檚 the earliest the state documents school vaccination rates and measles can be especially deadly for young children. The state鈥檚 two measles deaths this year were girls ages 6 and 8. Under Texas vaccine requirements, most kindergarteners must show they are fully vaccinated against measles or file an exemption to enroll in school; most who are not fully vaccinated have an exemption.

During the pandemic, the statewide measles vaccine delinquency rate 鈥� a term the Texas Department of State Health Services uses to track students not compliant with those requirements 鈥� more than doubled.

The Tribune estimated the number of vaccine-delinquent kindergarteners in each district by comparing delinquency rates and enrollment totals.

In school districts with the most delinquent kindergarteners in the 2024-25 school year, the latest data available from the state, as much as 44% of their kindergarteners were delinquent in the measles vaccines, and their delinquencies also outnumbered exemptions, which was not the case at the state level. Those school districts had vaccine delinquency rates as small as a fraction of a percent just five years prior.

The five other vaccinations required for kindergarten followed similar increases in delinquency rates during the same time period.

The pandemic is the driving force behind the increase in vaccine delinquency, school district officials say. Many children are entering school after falling behind on their immunizations during the pandemic, making it an untenable task for resource-strapped school districts to chase after parents to vaccinate their children or submit an exemption.

Meanwhile, access to vaccines, especially free and low-cost doses, have also dwindled over the last several years amid funding cuts and the politicization of vaccines.

State laws and rules don’t dictate who has to enforce vaccine compliance, although the Texas Department of State Health Services administers the law and school districts have traditionally been among the first line of enforcement.

While school districts acknowledge they are enrolling students not compliant with state vaccine requirements, district officials say they are caught in a no-win situation. Pushing vaccines too hard could lead to retaliation from groups and politicians opposed to vaccine mandates, and district officials don鈥檛 want to disenroll students 鈥� public schools have a responsibility to educate all children and so much of their funding is tied to attendance, too.

鈥淲e encourage our school nurses to advocate strongly to promote and protect public health at their campus,鈥� Becca Harkleroad, executive director of the Texas School Nurse Organization. 鈥淏ut ultimately it鈥檚 up to the superintendent and the principal to decide how strictly they are going to enforce it or if they are going to enforce it.鈥�

Statewide, the percentage of kindergarteners who were delinquent in getting the measles vaccine more than doubled to 2.68% between 2019-20 and 2024-25, the latest data available. The delinquency rate jumped to 3.1% in 2021-22, surpassing the number of students who had an exemption. Those rates have not returned to pre-pandemic levels, although the exemption rate has returned to exceeding the delinquency rate.

The federal Centers for Disease Control and Prevention estimates that a year ago 25,000 Texas kindergarteners were not fully vaccinated against measles. Of those, more than 16,000 had an exemption, and about 9,000 did not have an exemption and under the state鈥檚 definition, were vaccine delinquent.

The overall vaccine delinquency rates may be small, but anything that causes vaccination levels to fall means more children are vulnerable. Ideally, schools try to keep their vaccination levels at 95% to help protect those children with compromised immune systems or medical conditions that keep them from being vaccinated.

In addition to vaccine delinquency, the state also tracks the percentage of students who are vaccinated, formally exempt from vaccinations, and provisionally enrolled because of vaccination status.

Most unvaccinated students in Texas are permitted to enroll because they have an exemption form or a note from a doctor. They can also provisionally enroll without proving vaccination status if they are homeless, military dependents or in foster care and their records cannot be obtained by the start of the school year.

The Texas measles kindergarten vaccination rate of 93% is the lowest it’s been since at least 2011, ranking the state 18th nationally.

鈥淭he decrease in vaccination rates overall is certainly a concern because it leaves our population vulnerable to different infections,鈥� said Dr. Erin Nicholson, a pediatric infection physician at Texas Children鈥檚 Hospital and an assistant professor at Baylor College of Medicine. 鈥淎nd we saw that front and center with the measles outbreak that recently happened.鈥�

Schools: A first line of defense against infectious disease

By the time most children enter kindergarten, they have received two MMR vaccination doses, against measles, as well as mumps and rubella for most people. The MMR vaccination for kindergarteners is considered one of the .

State health officials audit school vaccination records each year for accuracy, by sampling school district records, explains Chris Van Deusen, spokesperson for the Texas Department of State Health Services. But there is nothing in state rules that requires DSHS to enforce the vaccination requirement.

As a result, the de facto enforcement has traditionally fallen to school districts.

Some of the state鈥檚 highest kindergarten measles delinquency rates were in larger school districts and charter networks: KIPP Texas Public Schools (44%), Spring ISD (30%), Austin ISD (23%), Dallas ISD (20%), and Houston ISD (7%).

The five public school systems with the highest counts made up more than half of all delinquent kindergartners in the state, despite enrolling less than 10% of the state鈥檚 public school kindergarteners.

Some district officials, including Dallas, say they try to follow state requirements by sending home students who do not have completed vaccination requirements or an exemption. But, they enroll those students, contributing to the district鈥檚 vaccine delinquency rate.

The Austin school district will also enroll the students who don鈥檛 meet vaccine requirements, but they wait to send those students home until their parents have been notified of their vaccine delinquency three times, Bejarano said. They can return once they have proof of vaccination or the exemption form.

State data doesn鈥檛 track how many vaccine-delinquent students school districts send home. It also doesn’t reflect changes to vaccine delinquency later in the year because the data is based on surveys school districts submit in the first half of the school year.

While some school districts say they try to send home students who don鈥檛 meet vaccine requirements, Houston ISD officials said they are keeping those students in the classroom. They, too, dedicate time and resources to track all students鈥� vaccination status and try to communicate information with parents about the need for staying up to date on the schedule.

But, they are 鈥渘ot excluding students from learning based on vaccine status,鈥� according to a statement to the Tribune.

Chanthini Thomas, a school nurse who retired from her job at Houston ISD鈥檚 Bellaire High School last summer, said the conflicting messages from the district, resource reductions and the yearlong chase to get vaccine paperwork in was frustrating.

鈥淵ou have little support,鈥� she said. 鈥淲hy would you say鈥hat鈥檚 a requirement to any school for the state of Texas but then you put out a mandate from the district to say, don鈥檛 let immunizations prevent enrollment? And the reason is because they need the numbers, because the numbers were dwindling.鈥�

Like many other urban school districts, HISD is battling 鈥� and the funding that comes with it 鈥� as more families move toward better job opportunities and lower housing costs in the suburbs or choose charter and private schools.

As school nurses have told the Tribune over the summer, school districts choose to enroll unvaccinated children so they can keep 鈥渂utts in the seats鈥� and the base amount of money they receive from state and local sources to educate each student 鈥� .

鈥淚 see the school as being in a tough spot,鈥� said Melissa Gilkey, a University of North Carolina professor who studies vaccine efforts at schools. 鈥淲e work so hard to minimize absenteeism鈥hat I do have some sympathy for that idea that it’s hard to exclude them for one health service.鈥�

KIPP Texas Public Schools, a charter network with campuses across the state, declined an interview but insisted it was following the state immunization requirements. Its kindergarten measles vaccine delinquency rate was less than 1% in 2019 compared to 44% last year.

Spring ISD, north of Houston, reported last year that more than 30% of its kindergarteners were measles vaccine delinquent. The district informed the Tribune it also follows state rules closely but said its high MMR delinquency rate was evidence of 鈥渆nrollment and access issues鈥� and that Spring ISD was 鈥渁ctively working to strengthen this process.鈥�

The Spring district cited family鈥檚 frequent moves in the area, limited access to health care and language barriers as reasons there鈥檚 a delay in getting student shot records updated in time for school.

鈥淲e are committed to improving compliance rates and ensuring our students are protected against preventable diseases,鈥� said Shane Strubhart, the Spring ISD spokesperson.

Access to vaccines has dwindled

The pandemic disrupted preventive health care, becoming most apparent in some of the most recent kindergarten classes, filled with students born around the first COVID-19 outbreak. The COVID-19 pandemic not only interrupted home and school life, experts say, it upended regular health checkups younger children typically receive before they start school and that impact continues to be felt today.

Families 鈥済oing to see the doctors got off track for everyone during the pandemic,鈥� Austin ISD鈥檚 Bejarano said.

For low-income and immigrant families who already found health care access a challenge, more are struggling to find what Bejarano calls their 鈥渕edical鈥� home, a regular primary care doctor who can either vaccinate their children or answer concerns and perhaps direct them to the state鈥檚 exemption process if they feel strong enough to opt out.

鈥淐OVID didn’t do vaccination or education and many other things as a whole, any favors,鈥� said Jennifer Finley, executive director of health services for Dallas ISD. The district鈥檚 kindergarten measles delinquency rate jumped to 20% last school year compared to 1% during the 2019-20 school year.

Diminished vaccine access is also a factor. Up until the early aughts, public health departments, churches and even lawmakers would hold free or low-cost immunization clinics over the summer for families.

In 2004, the Dallas school district turned away hundreds of students, who walked and drove to nearby clinics for free or low-cost vaccines, according to a Dallas Morning News article.

After the pandemic, those resources are even fewer.

鈥淚t really stopped during the pandemic,鈥� Finley said. 鈥淪ome of the folks lost their funding.鈥�

Schools rely heavily on local public health departments to help them with vaccination clinics. Once the threat of COVID lessened, public health departments used those funds to add more staff and hold more vaccination clinics.

But two things began by local health departments. First, those leftover funds were clawed back early by the Trump administration this year, prompting some staff to look for other jobs, thereby causing staff shortages in public health vaccination departments. And second, public health officials suspect more immigrant families are shying away from vaccination because of stepped-up immigration efforts and deportations.

In Texas, there are an , all of whom do not qualify for state Medicaid health insurance coverage, attending school.

鈥淲e typically have big lines and the waiting room is packed. Our whole lobby is packed,鈥� Dr. Phil Huang, the director of the Dallas County Health and Human Services Department, told the Tribune in August. 鈥淭his year it has not been that way.鈥�

Vaccine hesitancy changing school messaging

After the pandemic, many parents watched as debates raged over the safety of the quickly-developed COVID-19 vaccine. As a result, they are asking more questions about all childhood vaccinations.

In many cases, parents are spreading MMR doses out and that, too, could be the reason for more kindergartners showing up with an incomplete vaccination status, Bejarano said.

鈥淭he main concern [among parents] is basically, 鈥楢m I doing the right thing for my child, that is in their best interest and help me understand what the risks are of these infectious diseases that vaccines are trying to prevent,鈥欌�� Nicholson, the Texas Children鈥檚 physician, said.

Before COVID, many doctors adopted an imperial tone 鈥� 鈥測ou should do this because I鈥檓 the expert,鈥� she said. That changed after the pandemic. 鈥淲e are looking at how we talk to these parents, because the last thing that we want to do is come across as condescending.鈥�

School nurses have also worked tirelessly to try to find a winning formula to reach families of vaccine-delinquent kids. At a national school nurse conference in Austin this summer, an entire session was devoted to teaching nurses how to have tension-free conversations with parents who are skeptical of vaccine requirements.

Ultimately, school nurses just want to inform parents of their two options to stay compliant with state rules: either provide proof of vaccination or an exemption, Bejarano said.

鈥淲e鈥檝e made these large campaigns and we are really kind when they register, letting them know what is the law, what the exemptions [are],鈥� Bejarano said. 鈥淚 just think the district in general is understanding we need to do better when it comes to public health and getting these rates up.鈥�

The good news, she says, is that the greater efforts made by school nurses in the fall to try to help parents become vaccine compliant tends to push down the high delinquency rates by the end of the school year. Data provided to the Tribune by Austin ISD proved that out. That 23% delinquency rate for kindergartners recorded in the fall of 2024 fell drastically to 6% by May 2025 possibly due to the fear produced by the measles outbreak in the months prior.

鈥淚 do think that everybody came together in the Austin community and really did try to push for that鈥� compliance, Bejarano said. 鈥淎nd I think that鈥檚 why it helped the rate last year.鈥�

Finley points to other lesser-known reasons complicating the back-to-school vaccination picture. Among them, an influx of students came to Texas from other states, many already armed with vaccination exemptions or with incomplete vaccination histories who are having to be re-educated about Texas requirements.

Starting Sept. 1, Texas parents can more easily obtain a vaccine exemption form by downloading it off the state鈥檚 website, but how that will impact the delinquency gap won鈥檛 be seen until data is released next year.

Nicholson, Finley, Bejarano and others say they would like to see more data that clearly explains the rising delinquency rate and how many students who were once marked delinquent end up becoming fully vaccinated or obtaining an exemption by the end of the year.

鈥淒oes it mean, you know, people are just struggling with paperwork?鈥� Nicholson said. 鈥淥r does it mean that really those vaccinations are falling?鈥�

This first appeared on .

California is the first state in the country to , aiming to transform how children eat on campus by 2035. 

In the cafeteria of Belvedere Middle School in the Los Angeles neighborhood of Boyle Heights, Gov. Gavin Newsom signed a over the next 10 years. The requirements go above and beyond existing state and federal school nutrition standards for things like fat and calorie content in school meals.

California public schools serve nearly 1 billion meals to kids each year.

鈥淥ur first priority is to protect kids in California schools, but we also came to realize that there is huge market power here,鈥� said Assemblymember Jesse Gabriel, an Encino Democrat. 鈥淭his bill could have impacts far beyond the classroom and far beyond the borders of our state.鈥�

The legislation builds on recent laws passed in California to and certain additives from all food sold in the state when they are associated with cancer, reproductive harm and behavioral problems in children. Dozens of other states have since replicated those laws. 

The bipartisan measure also comes at a time when U.S. Health and Human Services Secretary Robert F. Kennedy, Jr.鈥檚 鈥淢ake America Healthy Again鈥� movement has shone a spotlight on issues including chronic disease, childhood obesity and poor diet. 

The term 鈥渦ltra-processed food鈥� appears more than three dozen times in the released in May. A subsequent report tasks the federal government with defining ultraprocessed food.

California鈥檚 new law beats them to the punch, outlining the first statutory definition of what makes a food ultraprocessed.

It identifies ingredients that characterize ultraprocessed foods, including artificial flavors and colors, thickeners and emulsifiers, non-nutritive sweeteners, and high levels of saturated fat, sodium or sugar. Often fast food, candy and premade meals include these ingredients.

Researchers say ultraprocessed foods tend to be high in calories and low in nutritional value. Studies have linked . Today, . 

Ultraprocessed foods are also linked to , .

Studies have found to be particularly harmful, said Tasha Stoiber, a senior scientist at the Environmental Work Group, which sponsored the legislation. Kids are particularly susceptible to the effects of ultraprocessed foods, she said.

鈥淯ltraprocessed foods are also marketed heavily to kids with bright colors, artificial flavors, hyperpalatability,鈥� Stoiber said. 鈥淭he hallmarks of ultraprocessed foods are a way to sell and market more product.鈥�

Gabriel said lawmakers and parents have become 鈥渕uch more aware of how what we feed our kids impacts their physical health, emotional health and overall well-being.鈥� That has helped generate strong bipartisan support for the law, which all but one Republican in the state Legislature supported. 

A coalition of business interests representing farmers, grocers, and food and beverage manufacturers opposed it. They argued the definition of ultraprocessed food was still too broad and ran the risk of stigmatizing harmless processed foods like canned fruits and vegetables that include preservatives. Vegetarian meat substitutes also generally contain things like processed soy protein and binders that may run afoul of the definition.

Gabriel contends that the law bans not foods but rather harmful ingredients. The California Department of Public Health now must identify ultraprocessed ingredients that may be associated with poor health outcomes. Schools will no longer allow those ingredients in meals, and vendors could replace them with healthier options, Gabriel said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit  to learn more.

This article was and was republished under the license.

PETERSBURG 鈥� Vernon Johns Middle School eighth grader Jonathan Phillips already knows he鈥檚 interested in a career in physics. With his interest in science, he was especially happy to witness the unveiling of his school鈥檚 new medical-focused classroom on Wednesday, a space made possible through a unique partnership between a Virginia health care system, an education nonprofit and Petersburg Public Schools.

鈥淚t seems like a very interesting learning opportunity,鈥� he said.

Phillips was one of a handful of middle school students to attend a formal ribbon cutting for the classroom opening where they听 were able to physically interact with various medical instruments and models. As he lingered near a model used for CPR practice, he noted how he鈥檇 taken a course and was excited at the prospect of 鈥渂rushing up鈥� on the life skill. Some other students expressed interest in phlebotamy, the specialty of drawing blood for testing or delivering intravenous medicines, while exploring the room.

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Phillips said the classroom may stir up his classmates鈥� curiosity about working in medical fields.

鈥淚 think some other people might have their interest piqued,鈥� he said.

Petersburg superintendent Yolanda Brown said that the lab will be part of Vernon Johns Middle School鈥檚 鈥渃areer investigation鈥� courses, offering hands-on experience that will encourage students to further their studies in health care. The school also aims to include guest lecturers in the classroom from different healthcare specialties.

Next door, Petersburg High School,offers a curriculum for certified nursing assistant career paths, which students could explore and plan to pursue or that might inspire interest in other medical professions. As Virginia mirrors national trends in a of workers for critical health professions like various types of nurses and primary care providers, Petersburg鈥檚 new medical classroom can help inspire future professionals who could stem the tide.

鈥淲e thought that starting early, at least at middle school, introducing them to those careers, those tracks and what they might need for their ninth grade start of high school, would be a place to start,鈥� said Communities in Schools Petersburg president Wanda Stewart.

Stewart鈥檚 organization is part of a national nonprofit dedicated to supporting local schools and students around the country. Communities in Schools Petersburg facilitated conversations with HCA Virginia Health System and the school division that led to a $25,000 grant that helped set up the classroom.

鈥淲e are excited about our students being able to learn in a way that is a little different from just normal classroom settings,鈥� Stewart听 said.

HCA awarded the grant to the school in order to inspire future health care workers, HCA associate vice president of academic affairs Yvette Dorsey explained at the unveiling.

A CPR training for students at Petersburg High added to the health-related learning Wednesday morning. The training stemmed from a collaboration between Petersburg schools, the local emergency services and health departments, and HCA.

With requiring public elementary and secondary schools to develop cardiac emergency response plans, the training was timely. The legislation was carried by Sen. Aaron Rouse, D-Virignia Beach, in this year鈥檚 General Assembly session and, after passing the legislature, was signed by Gov. Glenn Youngkin March 24.

is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Virginia Mercury maintains editorial independence. Contact Editor Samantha Willis for questions: info@virginiamercury.com.

Some Iowa representatives want to ban margarine and certain food dyes from schools with a bill modeled closely after a law passed last year in California.

was discussed in an education subcommittee Wednesday. Representatives decided to amend the bill, which as introduced included margarine, Red Dye 40 and Yellow Dye 7, to be 鈥渕ore closely conforming鈥� to the .

Rep. Jeff Shipley, R-Fairfield, who chaired the subcommittee, to ban margarine and hydrogenated vegetable oils from schools. The 2023 proposal passed its subcommittee, but did not advance.

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Rep. Heather Matson, D-Ankeny, opposed the margarine element of the bill, and argued research supports margarine is 鈥渏ust as healthy as butter.鈥�

鈥淚f you鈥檙e arguing that corn oil and soybean oil is fundamentally unhealthy for our kids, that鈥檚 also an important part of the conversation to have, because that is kind of what we鈥檙e saying in here,鈥� Matson said.

Matson said after further research into California鈥檚 law and the years of research from the state into associated health effects, she is 鈥渙pen to a conversation鈥� about restricting the color additives.

Matson also questioned why the Iowa bill specified just Red Dye 40 and Yellow Dye 7, the latter of which, according to comment submitted by the International Association of Color Manufacturers, is not used in food or beverages.

The California law outlaws the dyes Blue 1, Blue 2, Green 3, Red 40, Yellow 5 and Yellow 6. The law also regulated the percentage of fats, sugars and saturated fats that could comprise a school meal, though these elements were not part of the Iowa representatives鈥� discussion.

Matson pointed out the California law passed years after the state funded an in which the California Office of Environmental Health Hazard Assessment found synthetic food dyes can be linked to hyperactivity and neurobehavioral problems in children.

Matson said she was unwilling to sign off on the bill as is, but would be 鈥渨illing to have a conversation on a bill that would be more thoughtfully put together.鈥�

Rep. Brooke Boden, R-Indianola, said she was 鈥渆xtremely glad鈥� the issue of food dye additives was before her and that she鈥檇 be the first to vote in favor of removing the synthetic dyes.

鈥淚 have a child who sees a neurologist, who asked us to remove food dye, and it significantly changed my child鈥檚 life,鈥� Boden said.

Boden noted there has been movement on this effort at a federal level as well with the U.S. Food and Drug Administration鈥檚 recent ban of .

Representatives for Rural School Advocates of Iowa, Urban Education Network of Iowa, and Iowa State Education Association, who registered as undecided on the bill, said they felt positively about the direction of the bill, but wanted to know more information about how it would be implemented in Iowa schools and if there would be additional costs.

Shipley moved to amend the bill to more closely resemble the California law, and to keep margarine in the bill 鈥渇or now,鈥� noting it might be reasonable to split the issues into separate bills later.

鈥淚 think these are conversations that people of Iowa are wanting to have, and so I think it is incumbent on us to reflect that and make sure we are having as wide ranging a dialog as possible,鈥� Shipley said.

is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Iowa Capital Dispatch maintains editorial independence. Contact Editor Kathie Obradovich for questions: info@iowacapitaldispatch.com.

This was produced by  a nonprofit, nonpartisan news outlet focused on education.

Over the past few years, it鈥檚 become clear that states need more money to support kids.  is long gone, but effects from  still linger, evident in persistent child care shortages and ongoing child behavioral and mental health concerns. Now, states are increasingly trying to generate new sources of money to support young children, although in at least one state, a ballot measure was designed to pull back on just these kinds of efforts.

At least a dozen measures were on ballots across the country Tuesday, proposing tax increases or new revenue streams to pay for child care and other child-focused services. Voters overwhelmingly chose to maintain or increase spending on these initiatives 鈥� though there were some holdouts.

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Here鈥檚 a look at how early childhood fared this election: ()

Child care:

 Washington state:  aimed to repeal a capital gains tax that passed in 2021 and has since provided child care subsidies and money for select child care programs. By failing, the tax and funding stream for child care will remain in place. 

 Travis County, Texas:  called for a property tax increase to raise more than $75 million to create affordable child care spots and mitigate the loss of federal pandemic funds for local child care programs. 

 St. Paul, Minnesota: The 2024 Early Care and Learning Proposal is a property tax levy aimed at providing public funding to child care. The city would raise $2 million the first year and add an additional $2 million each year until year 10, with this money going into a special early care and education fund that would . (The city鈥檚 mayor, Melvin Carter, said he was  if it passed). 

Sonoma County, California:  asked voters to approve a quarter-cent countywide sales tax to create a local revenue stream that would help pay for child care and children鈥檚 health programs, with a special emphasis on children who experience homelessness. The initiative gained over 20,000 signatures from registered voters to qualify for the November ballot. 

 La Plata County, Colorado:  will redirect up to 70 percent of revenue from a lodger鈥檚 tax toward child care and affordable housing. 

 Grand County, Colorado: Ballot Measure 1A will increase the county鈥檚 lodging tax from 1.8 percent to 2 percent, with the revenue paying for tourism, housing and child care. 

 Montrose, Colorado:  will increase the city鈥檚 hotel tax and put 17 percent of the revenue toward local child care. 

Early childhood health, education and well-being:

 Platte County, Missouri:  measure calls for a quarter cent sales tax increase to create a revenue stream for mental health programs, including early childhood screening. 

Pomona County, California:  aims to reallocate at least 10 percent of funds in an existing city general fund to create a Department of Children and Youth. The funds would also be used to pay for youth programs, child care and support for parents. 

Santa Cruz, California:  proposed a $0.02 per ounce tax on sugar-sweetened beverages to raise funds that can be used for youth mental health and programs for children. 

 Colorado:  aims to establish a $39 million fund by imposing a 6.5 percent excise tax on guns and ammunition. While most of the money is directed at crime victim and veterans mental health services, $3 million will fund behavioral health services for children. 

 Missouri:  would have established a new gambling boat license, with the estimated $14 million in revenue funding public school early childhood literacy programs. 

 Nevada:  on the ballot this year gave voters the chance to exempt diapers from sales tax, starting on January 1, 2025. 

A Western Kentucky University student has a confirmed case of measles and may have exposed others, according to the Barren River Health District and the Kentucky Department for Public Health.

The student is unvaccinated against the highly contagious disease, the health departments said.

The student, whose name, gender and other identifying information were not released, recently traveled internationally. This is where they 鈥渁re presumed to have been exposed to measles.鈥�

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Upon returning, and 鈥渨hile infectious with measles,鈥� the student attended public events on Aug. 28, 29 and 30, the health department said.

People who were at the following locations may have been exposed:

• The Commons at Helm Library (WKU)
  • 1906 College Heights Blvd #11067 in Bowling Green
  • Wednesday Aug. 28, 2024, (7:45 a.m. 鈥� 10  am and 8 p.m. 鈥� 10:30 p.m.)
  • Thursday Aug. 29, 2024, (7:45 a.m. 鈥� 10 a.m.)
  • Friday Aug. 30, 2024, (7:45 a.m. 鈥� 10 a.m.)
• WKU student union Starbucks
  • 1906 College Heights Blvd in Bowling Green
  • Wednesday Aug. 28, 2024, 6:30 p.m. 鈥� 9:30 p.m.
• Simply Ramen restaurant trivia night
  • 801 Campbell Lane in Bowling Green
  • Thursday Aug.  29, 2024, (7 p.m. 鈥� 11:00 p.m.)

Measles 鈥渟preads easily when an infected person breathes, coughs or sneezes,鈥� . It can cause serious complications and death, according to WHO, which reported most deaths from measles in 2022 were in unvaccinated children.

Vaccination is the best defense against measles, WHO says.

The Centers for Disease Control and Prevention recommends a first dose of MMR vaccine for children 12鈥�15 months and a second dose between ages 4鈥�6. Teens and adults should also stay up-to-date on this vaccine, , which is generally available at pharmacies.

Symptoms of measles are fever, cough, watery eyes, runny nose and rash.

If you have questions about exposure or your risk, call your healthcare provider or the Barren River District Health Department at 833-551-0953.

is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Kentucky Lantern maintains editorial independence. Contact Editor Jamie Lucke for questions: info@kentuckylantern.com. Follow Kentucky Lantern on and .

Illinois public schools wishing to teach their students about the dangers of overdoses and substance use disorder now have a blueprint to do so from the state.

The Illinois State Board of Education published the resource guides in accordance with a law passed in 2023. While a school鈥檚 use of any of the state鈥檚  is voluntary, some public health advocates consider the creation of the guides a step in the right direction. Administrators and educators can download age-appropriate presentations, lesson plans or fact sheets.

Various courses developed by  nonprofits and federal agencies provide options for curricula about what prescription drugs are, the science of drug interactions, harm reduction, and how to manage medication alongside mental health struggles. Complexity increases with age; high school resources include lessons on different classes of drugs.

Some links connect to materials or videos from the National Institute on Drug Abuse and a 鈥渧irtual field trip鈥� produced by the .

One resource referenced multiple times in the guides, , was developed in part by Cardinal Health, a pharmaceutical distributor who paid out part of a  with 45 states, , in 2022.

Overdose remains a leading cause of accidental death in the state and across the country, something not lost on the various public health organizations that supported the legislation to create the guides. The Illinois Harm Reduction and Recovery Coalition, an advocacy network of organizations and individuals dedicated to , released a statement praising ISBE and the Department of Human Services for their work but said there was a 鈥渓ack of opportunities鈥� for more involvement from community members.

During 2022 鈥� the most recent year with comparable data 鈥� more than  people died of an overdose in Illinois, while almost  were killed by firearms, according to the U.S. Centers for Disease Control and Prevention. That same year, more than  people in Illinois died due to a traffic accident, according to the Illinois Department of Transportation.

The law requiring the guides  the House and the Senate unanimously. It鈥檚 known as Louie鈥檚 Law in honor of Louie Miceli, who died of an overdose in 2012 at 24 years old.

Felicia Miceli, Louie鈥檚 mother, said he was first exposed to opioids at age 17 following a high school football injury.

鈥淲e know this guidance will equip communities with vital information, tools, and resources,鈥� Miceli said in a . 鈥淏ut only if they know about it and have an implementation plan.鈥�

The Illinois Harm Reduction and Recovery Coalition and the LTM Heroin Awareness and Support Foundation 鈥� which Miceli started in honor of her son 鈥� released a statement celebrating the 鈥渇irst-of-its-kind鈥� guides but also said the process could have benefitted from including more perspectives while crafting various guides.

鈥淭he organizations are concerned about the lack of opportunities for broader stakeholder involvement in the guidelines鈥� development, including the primary target audiences (and) marginalized groups,鈥� the release reads.

Last year, 30 teenagers in Cook County died due to drug toxicity, according to the .

 is a nonprofit, nonpartisan news service covering state government. It is distributed to hundreds of newspapers, radio and TV stations statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation, along with major contributions from the Illinois Broadcasters Foundation and Southern Illinois Editorial Association.

Chris Riback: Rotimi, thanks so much for coming by the studio.

Rotimi Kukoyi: Yes, I’m glad to be here today.

Chris Riback: First of all, I just wanted to say how sorry I am you had such trouble getting into college. Only 12 out of 12 accepted you?

Rotimi Kukoyi: 15, actually.

Chris Riback: 15 out of 15?

Rotimi Kukoyi: Yes, sir.

Chris Riback: Who is the big winner?

Rotimi Kukoyi: UNC Chapel Hill. Go, Heels.

Chris Riback: Go, Heels. You are interested in educational and health equity with the aim of expanding access to our nation’s institutions, and you hope to pursue an MD/MBA?

Rotimi Kukoyi: Yes, that’s correct.

Chris Riback: What are educational and health equity?

Rotimi Kukoyi: Educational equity is making sure that our education system is properly equipped to provide students from all backgrounds with equitable opportunities in education. Education should not be limited by a student’s income or geographic area or their parents’ education status, and unfortunately it is, but there are a ton of great educators, many of them here, doing work to make sure that we can close those barriers and help promote mobility for students from all backgrounds. Health equity, people tend to get health equity confused with DEI, and while they have some overlap, they’re still very distinct concepts. Health equity is trying to ensure that we have equitable outcomes in patients. We saw this during the COVID pandemic, that our health system and its infrastructure are not properly equipped to provide adequate services for people from several different marginalized backgrounds. I hope to use my medical education to help close some of those gaps and promote quality of life for people from all walks of life and backgrounds.

Chris Riback: How do the two connect? How does health equity connect with educational equity?

Rotimi Kukoyi: I think equity, in a lot of different spheres, it connects as a whole, but educational equity is directly tied to health equity through health literacy, then also socioeconomic status. Education, as I alluded to a little bit earlier, is one of the biggest mobilizing forces available for people. No matter what income you’re born into, if you’re able to pursue an education successfully, that can open up so many doors for you and you can begin to close the doors of intergenerational poverty and open up more opportunities for the people that will follow you. Health equity is trying to ensure that people can live longer lives and healthier lives. If you have students that are in school and they’re not able to get access to health resources, that can limit their education. Vice versa, if you have people in the health system and they’re not able to properly understand their communication with their doctors, that can limit their ability to follow their health regimens, to pursue healthy lifestyles, and then there are also barriers associated with poverty and even having opportunity to pursue a healthy lifestyle. It’s all so interconnected.

Chris Riback: It all connects. What inspired you to go down this path?

Rotimi Kukoyi: Yes, so educational equity, that is something that came from some research I did in high school. I did a year-long research project on trends in the Black/white ACT score gap in Alabama. That experience was so empowering for me, because for my whole life, I had seen underrepresentation in the classroom, despite going to diverse schools. I had seen the opportunity gaps between Black and white students and I thought it was an individual issue. Our school system, our curriculum, it didn’t explain the systemic backgrounds for these gaps we were seeing today. In doing my research, I learned about the role between wealth and neighborhood and educational attainment. I realized that this issue is so much bigger than they tell us students. That was something that I realized that, even though I don’t want to pursue education as a career, I still think it’s so important, so I remain engaged with it.

I’m mentoring students who are applying to college now for free. In fact, on the train here yesterday, I read four different essays of people I don’t know, but it just fulfills me. Healthcare, I’ve just always been interested in problem solving, but specifically, I love the direct impact that medicine and health has on the human condition. I love biology, but I also have learned, since coming to UNC and getting exposed to public health through its great public health school, the Gillings School of Global Public Health, and just different opportunities through my scholarship and education. I’ve realized that healthcare as a system is so flawed and your opportunities to impact lives are limited to that clinic. You are treating patients on a one by one basis often, being limited by the bureaucracy of healthcare.

Chris Riback: Yes.

Rotimi Kukoyi: If you really want to impact patients, you have to be able to impact health through community initiatives, through hospital reform, and that’s where that MBA piece comes in. I want to learn how to work with systems and how to innovate and think creatively for some of these problems

Chris Riback: Really get outside of the single clinic and scale the solutions that, I assume, you hope to design.

Rotimi Kukoyi: Yes.

Chris Riback: Why are you at the conference today?

Rotimi Kukoyi: I’m at the conference today as part of the Public Voices fellowship of the Op-Ed project and partnership with the NBCDI. I applied to this fellowship during the march of my freshman year of college, because I was interested in, again, learning and engaging with others about how we can make childhood more equitable. A lot of these inequities that we see, people aren’t born with them, but there’s something that starts to develop as early as preschool. They continue and continue and continue to compound.

Chris Riback: They might be born into them.

Rotimi Kukoyi: Exactly. They’re born into them, and these structures need reform, so I wanted to join a community of people that were engaging with this issue from so many different walks of life, so many different perspectives, and today we had the chance to have an in-person convening and it’s been awesome.

Chris Riback: You spent last summer in Grand Rapids, Michigan.

Rotimi Kukoyi: I did.

Chris Riback: Why were you there?

Rotimi Kukoyi: My scholarship program, the Morehead-Cain Scholarship, it has four different summer pillars and, for our second summer of college, what we do is they have something called “Civic collab.” They send teams of scholars and four to five people, and then you’re sent to different cities across the country. There’s even a team in Canada this year, and you’re partnering with nonprofits or civic agencies or government agencies to help work on civic issues. I was a group of four other scholars in Grand Rapids, we are partnering with Coral Health and the CUSI Business Ethics Initiative from Grand Valley State University. We were working with Coral Health, the nonprofit health system, to make healthcare more accessible for people in the Grand Rapids community and promote health equity, and it was a great experience.

Chris Riback: You’re here at this NBCDI conference, which is all about helping empower and educate and generate opportunity for parents and children and communities all across the country. What would you say to some of those children who a place like this is trying to impact kids who might not have the ability to dream as big as you obviously do, or might see you and say, “Yes, him. That’s who I want to be.” What would you say to those kids?

Rotimi Kukoyi: I would say don’t be afraid to deviate from the single story. The media and a lot of our communities like to perpetuate this single idea of the Black child, which is something that authors like Jerry Craft have been working on dismantling, but you have to actively seek exposure to people doing all sorts of different cool things. I’m walking my own path, which I’ve learned from meeting with a bunch of different people and traveling a lot, and just getting exposure to the world. It really all just comes down to realizing that the image that people will try and project on you does not have to be the image that you want to walk in your life. Sometimes doors won’t be open for you, that might mean you have to reach your own door.

You might have to actively reach out and advocate for yourself over and over again, and it can be tiring, but you have to stick with it, because it will be worth it when you’re able to identify what your story is, what you want your story to look like, and how you’re going to use that story to impact others in a way that fulfills you.

Chris Riback: That’s a powerful and important lesson. Lastly, a little bit tongue in cheek, most important question for some people. Who’s going to win the ACC basketball tournament this year?

Rotimi Kukoyi: Obviously, I think UNC. We’re in a great spot, we have a great recruited class, we have some veteran players returning for the season. I think it’ll be an easy sweep, and even more importantly, I think when we play Duke, we’re going to crush them.

Chris Riback: We heard it here first. Rotimi, thank you. Thank you for coming to the studio.

Rotimi Kukoyi: Thank you for having me.q

鈥�,鈥� Dr. Josiah Rector鈥檚 dense, deeply researched history of Detroit鈥檚 water disasters, lays out the origin story of this most recent catastrophe. Beginning with the mid nineteenth century, Rector meticulously layers fact upon fact to detail how politics, policy and societal changes ebbed and flowed in Michigan鈥檚 largest city over multiple generations to create a witches鈥� brew of race, class and gender inequalities that translated into polluted water and scandalous policies. If Rector鈥檚 cataloguing of these events has a certain here-we-go-again, rinse-and-repeat quality, it鈥檚 because since the late 19^th century through present day, Detroit鈥檚 history has seen incessant waves of income inequality, unregulated mass-produced industry, lackadaisical or non-existent financial regulation, environmental degradation and unrelenting racial segregation.

Along with this history of metastatic industrial development, staggering pollution, relentless corruption and breathtakingly bad policy, Rector presents the other side of the coin: the fierce, courageous, dogged commitment of activists pushing back decade after decade, demanding cleaner air, better working conditions and water that wouldn鈥檛 poison their children. Rector draws on dozens of oral history interviews and extensive archival research to tell in relatable terms what is likely the most comprehensive history of Detroit鈥檚 environmental justice movement to date.

At the heart of the issues raised in 鈥淭oxic Debt鈥� is the question of whether access to water should be considered a human right available to all, or a commodity available to whoever can pony up sufficient money to pay a water bill. The irony baked into this question since Detroit鈥檚 earliest days is the fact that what Rector calls the 鈥渄ehydration of Detroit鈥� has occurred in an urban area surrounded by the largest freshwater system in the world.

Throughout the Rust Belt in the 1990s and 2000s, union busting, cuts to welfare programs and neoliberal trade policies that sent thousands of jobs to Mexico took a toll on America鈥檚 working class. For Michigan鈥檚 Black-majority cities, like Detroit and Flint, the toll was even more profound as decades of racist housing policies, white flight, and industrial and commercial disinvestment hollowed out the cities鈥� economic core.

Rector doesn鈥檛 mince words in laying the water disasters of both Flint and Detroit solidly at the feet of neoliberal policies of austerity, deregulation and privatization throughout the 1990s and 2000s. Wall Street shares a sizable part of the blame as legislation during President Bill Clinton鈥檚 tenure removed the firewall between commercial banks, investment banks, securities firms and insurance companies, supercharging Wall Street鈥檚 affection for mergers and acquisitions and enabling commercial banks to make increasingly risky investments. Investment banks marketed high-risk 鈥渟waps鈥� to cities and Detroit, among many others, took the bait.

In 2013-2014, Detroit declared bankruptcy, resulting in Republican Gov. Rick Snyder suspending democracy via Michigan鈥檚 Emergency Manager laws, which gave the state the power to impose economically and environmentally disastrous policies without any accountability to the residents. Snyder put Detroit under an emergency manager and imposed radical austerity measures that shut off or poisoned the water of hundreds of thousands of Americans 鈥� largely African American families 鈥� living there. (For a look at how these decisions created the public health catastrophe of Flint鈥檚 water system, see our review of Dr Hanna Attisha鈥檚 鈥�.鈥� Different calamity, same players and policies.)

During this time, Detroit鈥檚 poor and working-class African Americans became a lucrative market for subprime loans, which treated home mortgages as a casino. Balloon fees led to out-of-control mortgage payments and as the families struggled to make these mortgage payments, they fell behind on their water bills. Rather than come up with ways to mitigate these payments, as had been done during the Great Depression, the city just cut off the spigot. As the city handled its bankruptcy 鈥� the largest in U.S. history 鈥� it made a bargain with its creditors and bondholders. Unsecured creditors 鈥� pension funds representing thousands of active and retired municipal workers and their families 鈥� had to take what the financial wizards called a 鈥渉aircut,鈥� meaning they paid for the city鈥檚 bankruptcy while the banks and insurance companies came out fine.

Two-thirds of the water cutoffs involved children. In a cruel Catch-22, child welfare authorities removed children from their homes because of a state requirement that all homes housing children have working utilities. On June 25, 2014, the U.N. Office of the High Commissioner of Human Rights released a statement calling Detroit鈥檚 policy for shutting off people who couldn鈥檛 pay 鈥渁n affront to human rights.鈥� Protesters took to the streets demonstrating against the shutoffs and blockaded the dispatch facility to stop the trucks leaving to perform shutoffs.

U.N. officials visiting Detroit at the invitation of the Michigan Welfare Rights Organization and the Michigan Coalition for Human Rights found examples of the indignities families suffered from the shutoffs, such as the mothers whose daughters had to wash themselves with bottled water during their periods, parents with asthmatic children who couldn鈥檛 operate nebulizers without water, families unable to adequately bathe themselves and clean their homes. The U.N. experts said the shutoffs violated international human rights laws including the right to water and sanitation, and the right to non-discrimination.

Even as the infamous unfolded, Gov. Snyder鈥檚 policies were contributing directly to increased lead poisoning among Detroit鈥檚 children as well. Austerity cuts to the Department of Health and Wellness led to the department ending its lead abatement program, despite evidence of 鈥減ervasive exposure鈥� to lead among the children of Detroit 鈥� nearly twice the level in Flint. According to the Centers for Disease Control and Prevention, no safe blood level of lead in children has been identified and even low levels of lead have been shown to negatively affect a child鈥檚 intelligence, academic achievement and ability to pay attention.

Austerity measures and outsourcing also led to a toxic water disaster in Detroit鈥檚 schools, as hundreds of the district鈥檚 unionized maintenance workers were laid off, accelerating the physical decay of its buildings. In 2016, Detroit Public Schools officials discovered toxic levels of lead and copper in 19 out of the district鈥檚 62 tested schools. As Rector writes, 鈥淔ar from fixing DPS, austerity policies had transformed centers of learning into sources of permanent brain damage for unknown numbers of children.鈥�

It would be satisfying to report that these matters are all safely in the past and Detroit residents have finally gotten a fair shake and fresh water. Sadly, that is not the case. In March 2020, Gov. Gretchen Whitmer responded to activists鈥� demands for action by issuing an Executive Order requiring that all public water utilities restore water service to any residence where water had been shut off due to non-payment. The policy would only last through the end of the pandemic. Detroit has extended the shutoff moratorium through 2022 but has shown little support for progressive water rate structures.

Rector writes that the water disasters of Detroit and Flint demonstrate the 鈥渉orrific human costs of sacrificing basic environmental health protections to the short-term financial interests of bond-holders and private contractors.鈥� A major takeaway of 鈥淭oxic Debt鈥澨齣s how misguided the free-market approach to public services is. Privatizing has an incredible allure to investors, but 鈥渆fficiencies鈥� most often lead to underfunding the resources necessary for the long-term health and viability of an economy and a society. Public systems should be accountable to the public.

According to by the Centers for Disease Control and Prevention, body mass index (a common measure of weight relative to height) in a sample of 430,000 children increased between March and November 2020 at nearly double the rate that it did before the pandemic began. The changes were especially prevalent among elementary-aged children, as well as those who were already overweight or obese.

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Dietician Michelle Demeule-Hayes, the director of at Baltimore鈥檚 Mt. Washington Pediatric Hospital, called the trends 鈥渟taggering.鈥�

鈥淚t鈥檚 never been this bad,鈥� she added. 鈥淪o the research is definitely accurate.鈥�

The CDC鈥檚 findings echo those of other research released in the past few months. by the Journal of the American Medical Association (JAMA) showed that rates of overweight and obesity have soared among children measured in California between the ages of 5 and 17. Two others 鈥� one and appearing in the journal Pediatrics 鈥� found that the weight gain was greater for certain demographic subgroups, including Hispanic, African American, publicly insured, and low-income children.

The spate of publications suggests a national spike in pediatric weight gain as kids have been restricted in their movements outside the home.

Corinna Koebnick, a nutrition scientist at Kaiser Permanente Southern California and a co-author of the JAMA paper, wrote in an email that it was 鈥渟afe to say鈥� that children have gained weight during the pandemic, and that it was unclear whether opening schools to in-person learning will be enough to reverse the trends that have taken hold.

鈥淭he increase in obesity over the 11 months [we] analyzed compares to the increase seen in national data over almost the last two decades,鈥� Koebnick said. 鈥淐hildren who have social and financial disadvantages, who live in school districts with less money or…less access to parks and meal programs may have additional challenges returning to healthy weights.鈥�

Koebnick鈥檚 study used Kaiser Permanente electronic health records for over 190,000 children whose body-mass index (BMI) was measured during a medical visit both before and during the pandemic. Researchers divided patients into three age groups (those between the ages of 5 and 11, 12 and 15, and 16 and 17) and studied their tendency to be overweight (at or above the 85th percentile of BMI for age) or obese (at or above the 95th percentile.)

Children in all three age groups gained more weight during the pandemic than they did before. But elementary-aged kids saw the biggest relative gains, with an average increase of BMI of 1.57, compared with an increase of 0.91 for the next-youngest group and 0.48 for the oldest. Adjusted for height and translated into actual weight, those figures indicate average gains of 5.07 pounds, 5.09 pounds, and 2.27 pounds for the respective groups.

Overall, the portion of 5-11-year-olds who are classified as overweight or obese is now 45.7 percent, up from 36.2 percent before the pandemic. The same figures rose by 5.2 percent among 12-15-year olds and 3.1 percent among 16- and 17-year-olds.

Demeule-Hayes, said that the wave of research on pandemic-related weight gain reflected the reality she and her colleagues face every day. Some patients referred to her, none older than 17, weigh as much as 400 pounds, and it has become typical to treat children diagnosed with what are typically seen as adult ailments, such as hypertension, high cholesterol, diabetes, and osteoarthritis.

Several papers already showcased the rising prevalence of type-2 diabetes. In both Washington, D.C., and Baton Rouge, Louisiana, researchers discovered that pediatric diagnoses of the dangerous and chronic condition approximately doubled in the year after school closures began. Among children diagnosed during that period, one study found that 60 percent required hospitalization for complications like severe hyperglycemia, compared with just 36 percent in the year before COVID emerged.

But Demeule-Hayes said that another common health complication of obesity, obstructive sleep apnea, poses particular risks for K-12 students.

鈥淭here are a whole lot of sleep disturbances with these kids because they’re tired, they’re not getting good-quality REM sleep,鈥� Demeule-Hayes said. 鈥淪o they’re coming home and taking naps, which just perpetuates that sleep-disturbance cycle 鈥� they can’t get to sleep later because they’ve taken a three-hour nap after school.鈥�

Experts are still investigating how the coronavirus changed the lifestyles of both children and adults. have shown that sales of packaged and processed foods shot up in the early months of the pandemic, and suggests that consumption of fresh foods declined. Demeule-Hayes pointed to the monthslong stillness that followed school closures, during which she watched her own young children learn from inside the house.

“Having them be on a computer literally all day, not having any of the recess or the steps outside or even just walking up and down the halls 鈥� they’ve been so, so sedentary,鈥� she lamented. 鈥淧re-pandemic, even if they were getting driven to school, they were still at least walking around the school and walking up one or two flights of stairs to classrooms.

According to tech firm SuperAwesome, the time children spent on screens each day after COVID-related closures began; 40 percent of kids aged 3-9 said they spent 鈥渕uch more鈥� time on screens. Respondents to of Canadian youth reported lower levels of physical activity, less time spent outside, more sedentary behaviors, and more sleep than before the pandemic.

As school districts around the country reopened for full-time, in-person learning, educators have welcomed back students whose lives were meaningfully 鈥� and perhaps permanently 鈥� altered by COVID. The extent of the academic damage is thought to be extensive, and hospital records suggest that many children may have suffered prolonged abuse while separated from their schools. On top of those severe setbacks, the bodily changes that some have undergone may prove long-lasting: Obese children and adolescents are as adults.

Koebnick recommended that parents limit screen time and encourage their kids to exercise and drink lots of water. Demeule-Hayes said that she recognized that some parents might still be leery of outdoor play given the dangers of the Delta variant. Still, she said, there was much that families and educators could do to combat further weight gain.

鈥淎s much as teachers and administrators can work [movement] into school time, they should. For parents, it’s taking walks as a family, after dinner, whenever you can work it in. Our message is always to make changes as a family so there’s not a stigma around a child’s ‘weight issue’; it’s really about making healthy changes for the family.鈥�

Men? Not so much. Other than jokes about sleepless nights, sexual slowdown and 鈥渄ad bod鈥� (more about that later), typically little attention has been paid to a man鈥檚 transition into parenthood. For the health of our families, it might be time.

Dr. Darby Saxbe, associate professor of psychology at the University of Southern California, says that, although the impact of that transition affects mothers and fathers in obviously different ways, it鈥檚 important to recognize that it鈥檚 a critical time for men.

鈥淭here鈥檚 been a blind spot when it comes to men鈥檚 health care and a focus on men transitioning to parenthood as the major life event that it is,鈥� Saxbe says. 鈥淚f we think about sleep, exercise, social interactions, life priorities, values 鈥� a lot of different domains go through major changes during this time.

鈥淚f you survey mothers and fathers, an equal percentage of fathers will say that being a parent is extremely important to their identity; it is a central part of their self-concept. But parenthood hasn鈥檛 always been a recognized value for men. That鈥檚 changing now, as fathers have really stepped up their participation in the last two or three decades 鈥� and that brings with it a growing awareness that fathering is a tremendously important and transformative life event that can have a lasting impact on father鈥檚 brains and bodies.鈥�

The U.S. has spent significant time and money addressing population-level health and treating stress-related disease, often focusing intervention efforts on late midlife. A case can be made for interventions and support much earlier, according to an of existing research that Saxbe collaborated on with Stanford University economist and family-leave policy expert Maya Rossin-Slater and developmental neuroscientist Diane Goldenberg.

Here鈥檚 why it鈥檚 so important. The transition to parenthood is a high-risk time for mental health issues such as anxiety and depression, with new parents about twice as likely as adults in other life stages to report clinically significant depression. Fathers often experience weight gain during this transitional time, possibly due to hormonal changes but also to not getting as much exercise as they might have before the baby鈥檚 birth, and other changing health habits. Families frequently default to grabbing whatever is easiest and quickest, so nutrition can take a nosedive as comfort food becomes the go-to rather than a treat.

Sleep loss is one of the legendary changes that parents experience during this transition, and fathers frequently wind up more sleep-deprived than mothers because they return to work sooner, given that the United States (unlike many countries) does not offer paid paternity leave. Lack of adequate sleep increases vulnerability to disease, obesity and mood disorders 鈥� all of which have an effect not only on individuals and families but even on the economy, with days missed and a lessening of productivity due to depression and illness.

鈥淲e know that a lot of chronic illnesses are linked with mood disorders, depression, sleep loss or disruption, increased stress and inflammation. All of these are dynamic across the transition to parenthood,鈥� Saxbe says. For many individuals, the weight gains during this time are retained long-term. Some people experience their first episode of major depression, and health markers such as stress and inflammation can get out of whack during this time 鈥� damage that can continue into midlife and beyond, she says. 听听

One of the most profound aspects of a father鈥檚 transition to parenthood is his loss of opportunity to get together with his friends and the changing social dynamics of existing friendships. If they aren鈥檛 fathers themselves, a man鈥檚 friends may not understand why he can鈥檛 hang out with them the way he used to. Dealing with the profound experience of having a new baby and his partner going through dramatic transitions without the social support of his peer group can be isolating and overwhelming for any man, with even less societal permission than mothers might have to express any level of unhappiness. Postpartum depression can be a deadly complication for women, and it can profoundly affect men as well.

Men sometimes have trouble coming to terms with the surprising physical changes their bodies go through during their partner鈥檚 pregnancy and postpartum months, Saxbe says. This time is full of changes in hormones and health behaviors, she says, so it would be surprising if there weren鈥檛 significant changes in the body during this period. What some might find surprising is the degree to which father鈥檚 and mother鈥檚 biology begin to synch up in preparation for the baby鈥檚 arrival and in the months afterward.

鈥淚n women, testosterone usually rises toward the end of pregnancy to help prepare the body for birth and then drops again,鈥� she says. 鈥淚n fathers, there is some evidence that testosterone declines over the transition to parenthood. But in our data, we鈥檝e also found that testosterone levels are linking up in couples transitioning to parenthood.鈥�

Dad Bod Isn鈥檛 Bad Bod

The combination of decreased physical activity, sleep loss, a less-than-ideal diet and decreased testosterone can result in 鈥渄ad bod,鈥� she says. Though the idea of having a dad bod might diminish some men鈥檚 self-image, from an evolutionary standpoint, it makes sense.

鈥淲e have a tendency as a culture to glorify testosterone and what it signifies 鈥� aggression, competition, dominance, status seeking 鈥� but there are times in the lifespan where priorities need to change,鈥� Saxbe says. 鈥淲hen a new baby is coming or is in the household, competing for a new mate might not be the best use of a man鈥檚 energy and time. In a society with a high child mortality, the most adaptive strategy for men might be to maximize the number of babies they can contribute genetic material to. But in a culture with more resources, where most children are likely to survive to adulthood, the more adaptive strategy might be to invest a lot in each of those children so that they not only survive but thrive.

鈥淭estosterone might dip in the prenatal or early postpartum period but then will often recover,鈥� she says. 鈥淚t鈥檚 just not the case that men need super high testosterone all the time throughout their lives.鈥�

Many criteria are important for successful parenting, but the fact of being genetically related to the child does not necessarily top the list. Saxbe says that significant research shows that good parents are made, not born: the act of caregiving creates 鈥�parenting brain,鈥� which doesn鈥檛 require a particular biological architecture, she says. This turns the gender script on its head and underscores that adoptive, foster parents and stepparents 鈥� anyone who develops meaningful bonds with children and is engaged in their care 鈥� are going to show the brain and biological changes linked with parenting. They, too, need to be included in any policy considerations.

What Serves Families Serves Society

Given the science that shows what an inflection point becoming a parent is for new moms and dads, as well as for families and for society, it would make sense for this to be a valued and protected time. In many countries, that鈥檚 the case. Among the 38 Organization for Economic Co-operation and Development countries 鈥� generally considered the 鈥渄eveloped countries鈥� of the world 鈥� the average paid leave for mothers is about 55 weeks. For fathers, total paid leave time is just over eight weeks. The U.S. ranks 38^th out of 38 on this list, with zero guaranteed paid time off for new parents 鈥� policy that simply does not set American families up for success. New moms in America are expected to bounce back after this profound, life-altering event: A quarter of new mothers return to work within two weeks of delivering a child, and typical maternity leave lasts only 10 weeks. Though the 1993 Family Medical and Leave Act provides for unpaid leave, almost half of U.S. workers aren鈥檛 eligible and those who are often can鈥檛 afford time off without pay.

鈥淧ublic policy support for families during this transitional time can protect lifespan health in a way that could save us some of the trillions of dollars we spend every year in the U.S. treating late-life disease,鈥� Saxbe says. 鈥淲e have this incredible amount of federal spending on healthcare, but we need to look at protecting families (at this time) as a kind of healthcare, given that the transition to parenthood is such a high impact time for health. Are we spending as effectively as possible if we鈥檙e not doing anything to help new parents?鈥�

U.S. policies put enormous freight on individuals to bear up under circumstances that shouldn鈥檛 be theirs alone. Society benefits when families get the support they need, including protected time off to heal, to bond and to become a family together 鈥� which has both immediate and lasting results.

鈥淭here鈥檚 evidence that mothers show better trajectories for stress and depressive symptoms and are more resilient across the transition to parenthood when fathers have paid paternity leave,鈥� Saxbe says. Paid leave for all new moms would make a huge difference for American families, but as Saxbe鈥檚 research is proving, it鈥檚 only part of the equation. Family leave might require significant investment, Saxbe says, but can save taxpayers money in the long run by lessening the burden of chronic diseases and creating healthier, happier and more stable individuals and communities. In the U.S., fathers have not typically been viewed as central to the childbirth and postpartum equation, but Saxbe鈥檚 and others鈥� research shows that, for the health of the mother, child and father himself, it鈥檚 time to broaden the conversation.

Chris Riback: Dr. Christopher, welcome to the studio.

Dr. Gail Christopher:听Thank you.

Chris Riback: Thank you for coming.

Dr. Gail Christopher:听It’s my pleasure.

Chris Riback: Congratulations 鈥� You are in the first month now in your role with the National Collaborative for Health Equity.

Dr. Gail Christopher:听Yes.

Chris Riback:听I just want to make sure, is it what you thought it would be and, probably more importantly, is it what they told you it would be? Was it a true bill of sale they gave you?

Dr. Gail Christopher: I created this organization a long time ago鈥�

Chris Riback: You knew what you were getting into.

Dr. Gail Christopher:听I knew what I was getting into, and I think the potential is amazing, so I’m very happy to be involved. Yes.

Chris Riback:听Excellent, so you have no one to blame but yourself.

Dr. Gail Christopher:听This is true every day.

Chris Riback: I read where one of your key goals, perhaps your top goal, you’ll tell me if I have that wrong, is to help America develop a true culture of health. What does a culture of health look like?

Dr. Gail Christopher:听A culture of health embodies the conditions that we know promote health and well-being. It’s the evolution of the social determinants of health framework where we began to realize that, really, 80% of those things that contribute to health and well-being, they happen outside of our interaction with the medical system, so it has to do with the quality of life which, in a country that’s built on the fallacy of a hierarchy of human value, the quality of life is often less for people of color, and so when we talk about health equity, we really know that we have to make the changes in our society that create conditions that will truly promote health for all.

Chris Riback:听Health isn’t about what happens in the doctor’s office. It’s about what happens everywhere else. Connect it for me to early childhood education. What in the world does a culture of health have to do with early childhood education?

Dr. Gail Christopher:听So many concepts have emerged in the last few decades. One is called the Life Course Perspective, and it understands that what happens to us both in utero and in early life affects our vulnerability for disease later in life, and so I like to think that the unifying concept is stress and distress, so, when we can create environments for children that optimize their ability to develop normally and naturally and minimize the trauma and the adversity and the stress, we’re actually creating an environment that is conducive to health, we’re creating a culture of health in the classroom, in the early childhood learning setting, and we’re actually developing young people in ways that will reduce their vulnerability to illness later in life.

Chris Riback: Last night, you gave the opening keynote address here at the NAEYC Conference, and one of your messages was we must promote equity and diversity in early childhood education. What does equity look like in early childhood education, and why is it so hard to attain?

Dr. Gail Christopher:听Equity looks like, quite honestly, equal access to quality early childhood education for all children, and it doesn’t matter the neighborhood, the ZIP code, the real estate value. It is quality education, and we know what it takes to promote and support optimal development for children, so equity means that we find ways to fund and assure access for all children, and it doesn’t matter their race, their religion, their gender, their location, so that’s one of the challenges.

Dr. Gail Christopher: The other thing is that resources make a difference, so we have to assure adequate funding investment in this very important phase of life, and that actually means paying the educators, the early childhood educators, the salaries that they need to experience less stress and to be more effective in their work, a living wage really.

Chris Riback:听A living wage, and, in listening to you, equity maybe begins with access, but, if I’m interpreting you right, access is just the starting point in talking about equity.

Dr. Gail Christopher:听We have to understand what are the barriers to equity, and part of the barriers are the basic lack of belief that all people deserve to be treated equal, and that’s another part of the work. Once we address the barriers, we then open up the stream of motivation to genuinely care and take the actions that are required.

Chris Riback:听Where do you expect, where do you hope, where would you insist the leadership to come from? You’ve worked in nonprofits. You have worked at Harvard University evaluating innovative approaches to government. I’m going to assume at some point in your life you’ve had some job in the private sector as well. Where does the leadership need to come from?

Dr. Gail Christopher:听In a democracy, I’ve learned that it’s a multisectoral strategy that’s required. In my last role at the Kellogg Foundation, we were able to orchestrate a mass collaboration of over 140 organizations to launch a truth, racial healing and transformation effort. The key there was that every sector, business, nonprofit, philanthropic, public, all sectors need to be represented. We do need strong leadership from the government and from the public sector. I think, if we put all the philanthropic dollars on the table, we would not be able to solve our societal needs, so we do need public sector leadership for sure, but I think collaboration is key.

Chris Riback:听Speaking of dollars and on the idea of equity, you provided testimony to The Helsinki Commission, the Briefing on Truth, Reconciliation and Healing, where you noted that, “The inequities caused by racism cost our nation almost $2 trillion annually in lost purchasing power, reduced job opportunities and diminished productivity,” and that made me think. Isn’t early childhood education in fact the place to start, that if we are thinking about the back end of society and that financial gap that you just identified is spending, investing and closing the gap at the front end, perhaps a place, the place to start building the foundation?

Dr. Gail Christopher: No question. You are absolutely right, and this is where the truth, racial healing and transformation becomes a necessary imperative, because most of the children in America today are in fact children of color, and so we have to get to a place where we really care that our future receives the investment that’s necessary to assure viability in a democratic society, and so universal access to quality early childhood education should be foundational to America.

Chris Riback:听Thank you. Thank you for coming by the studio. Thank you for the work that you do.

Dr. Gail Christopher:听Thank you for having me. It’s been a pleasure.