What is health?
Many people think of health in terms of medical care and physical health, or simply, the absence of sickness. But this is a limited definition. The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition, plus the recognition that drivers of health (DOH) account for 80-90% of health outcomes, exhibits the interdependent nature of health. DOH are defined as “all the circumstances in a person’s life that affect their health and quality of life status. These include access to quality health care, plus predominantly non-medical factors, such as education access and quality, access to and affordability of healthy foods, social connections and support, stable employment and housing, safe neighborhoods, clean air and water, and more.”
With this description of health as a background, let’s consider the status of childhood health in the US:
- In 2022, 1 in 5 children didn’t have enough to eat, which may lead to poor academic performance, increased health problems, and developmental issues.
- Between 2017 and 2020, 19.7% (14.7 million) of 2-19 year olds were obese, which puts children and adolescents at risk of poor health conditions like high blood pressure, high cholesterol, type 2 diabetes, etc.
- Between 2016 to 2019, 9.8% (6 million) of 3-17 year olds were diagnosed with ADHD, 9.4% (5.8 million) with anxiety, 8.9% (5.5 million) with behavior problems, and 4.4% (2.7 million) with depression.
This information highlights that we have clear performance gaps in childhood health that must be addressed if we seek to improve children’s outcomes—both near-term and for their long-term well-being. Modularity Theory may provide a lens on how to go about this.
An interdependent approach to childhood health
Modularity Theory (also known as the Theory of Interdependence and Modularity) states that when performance isn’t good enough and a system’s components are unpredictably interdependent—that is, the way one part is designed and functions depends on the way another part is designed and functions and vice versa—then the only way forward is for an organization to wrap its hands around the entire problem. One entity must address every critical component in the system so that it will function adequately. Then, once performance is good enough, the process can become standardized. This standardization creates a state where modularity can thrive, enabling many entities to compete to deliver one or more parts of a service more cheaply and quickly.
In the context of childhood health, to apply an interdependent approach, one entity would need to assume the responsibility for managing how the different parts of the system (quality health care, education access and quality, access to healthy foods, etc.) work together to create better health for children. This role could be taken on by a variety of systems, and one place we are seeing innovation is within schools and school districts. This makes sense since poor health, including acute illnesses, poor nutrition, chronic conditions such as asthma, mental illness, etc., results in lower educational attainment, educational setbacks, and interferes with schooling. Herein, I highlight innovators taking an interdependent approach to improving children’s health, from which others can learn.
Innovators in Interdependence
One example is the Cleveland Metropolitan School District, a school district in Ohio, which is focusing on nutrition to help their students build healthier lifestyles. They are currently partnering with a nonprofit called FoodCorps. FoodCorps partners with schools to provide nourishing, scratch-made, and culturally competent meals as well as food education. When they do so, eight AmeriCorps members will join schools in the district to work with nutrition staff, educators and students conducting taste tests, implementing a nutrition education curriculum, and more.
According to the FoodCorps website, “[k]ids in schools with more FoodCorps hands-on learning activities eat up to 3x as many fruits and veggies as students who receive less of that hands-on learning.” Increased consumption of fruits and vegetables has been seen to improve health. For example, a 2023 study of produce prescription programs found that the programs increased fruit and vegetable consumption in adults and children and decreased food insecurity. The programs also decreased blood pressure, blood sugar, and BMI in adults. Further, at the completion of the program, adults were “62% more likely and children were more than twice as likely to report better health status.”
This school district is taking an interdependent approach to health by focusing on both education and nutrition. Their partnership with FoodCorps to provide nourishing meals that are influenced by the students’ culture and voices help to support student health. In essence, they are taking responsibility for managing how education and nutrition work together to help enhance childhood health.
This example shows how schools can take a lead role in providing a more interdependent solution to improve children’s health by wrapping their hands around the multi-faceted issue of poor health. As schools are the organizations with the most access to children, they are well poised to do this type of work. Afterall, health is interdependent. And solutions to improve it must be as well, at least until the interfaces between various components of the system become more predictable and standardized. For now, much can be learned from innovators taking the lead.
