This post is a part of our Bioethics in the News series
By Sean A. Valles, PhD
California just passed two laws that advance health in schools in ways that might not seem intuitive: pushing middle school and high school start times to after 8am, and banning school districts from “lunch shaming” that treats students differently based on whether they have unpaid school lunch debt. These laws are part of a collection of diverse efforts to make U.S. schools healthier places. The fact that some of these efforts have been led by students themselves is especially heartening.
Bioethics of school policies
The two new laws in California are worthy of attention in a bioethics blog because U.S. schools are, for many students and in many ways, unhealthy places. Not simply because they are crowded spaces infamous for spreading coughs and colds (and stress). For many students, they are also places of food insecurity, social stigma, or even fear of violence. Those problems also shed light on larger problems in society. Even as a child in Los Angeles, I grasped that the local high school having a metal detector at the door signified that something much bigger had gone horribly wrong in my community. Most student problems have their roots outside the school walls, but we can at least do our best to design schools to contend with the difficult realities of young people’s lives.
There is now compelling evidence that later start times for schools are better for adolescent health than early morning ones. As pointed out in one review of the research, adolescents’ bedtimes seem to be more or less independent of when school starts in the morning, partly due to biological clock rhythms changing during puberty. Students forced to begin school early in the morning suffer all of the resulting harms of insufficient sleep (most readers are surely aware that insufficient sleep is bad for physical and mental well-being). This change is surprising in part because the American Academy of Pediatrics has, with limited success until now, been pushing for later school start times, insisting that school start times should facilitate the 8.5-9.5 hours of sleep appropriate for adolescent biology. It will be a difficult schedule transition for some California schools and families/guardians to adjust to, but the health rationale remains powerful.
Stigmatizing and manipulating students are problems, not solutions
It is also encouraging to see California legislate against lunch shaming. Unless prohibited, U.S. schools have the freedom to intentionally or incidentally shame students for being unable to afford their lunch meals. They have done so by giving indebted students inferior meals, marking the students with wristbands or stamps, etc. This is a serious health matter because imposing a stigmatized status upon a child, or even just amplifying an existing one, is a harmful act. Research is quite clear that stigma (“the co-occurrence of labeling, stereotyping, separation, status loss, and discrimination in a context in which power is exercised”) is a powerful and pervasive cause of health injustices. Stigma stresses bodies, socially controls people, and excludes them from social opportunities and resources available to others. Being a child without enough money to pay for lunch is quite hard enough, without one’s school officials metaphorically painting a target on one’s back.
The desirability of the California law gets clearer when one looks at a policy that goes in the opposite direction. In a widely-criticized lurch backwards, a newly-created policy in a New Jersey school district gives discretion to principals to ban students with lunch debt from participating in extracurricular activities. Which students? Under which circumstances? What goals are achieved by such exclusions? Certainly banning students from soccer practice or chess club doesn’t make money magically appear in their parents’ pockets. The policy is a setback, but I am encouraged by the backlash that gives a new sense of clarity to how remarkably regressive this policy is in light of the opposite trend.
Student advocacy should be welcomed
Most encouraging to me is the fact that students are advocating for themselves and the health of their schools. I am glad that the American Academy of Pediatrics and some California state legislators are advocating for healthier schools, but I have argued at length elsewhere that it is preferable to empower people advocate for themselves. And so students are. For instance, they have been at the forefront of a series of lobbying efforts (successful in Oregon and Utah) to get mental sick days recognized as legitimate reasons for missing school.
It is no coincidence that this push to create space for “mental health days” comes in the middle of a period of worsening mental health of young people in the U.S. Deaths from suicides just replaced deaths from homicides as the second leading cause of death among 15-19-year-olds (deaths from traffic accidents are down, but still exceed both). And homicides are also a target of student activism; after the Parkland school shooting, young people became the unexpected leaders of a new wave of gun control activism.
The late 2010s have been a time of disorienting rapid change, but I suspect that future historians will highlight one global social phenomenon: young people demanding a better world. The most prominent example is the rise of young climate change activists around the world—Greta Thunberg being the most famous—demanding action with a new sense of clarity and resolve. As I write this, Teen Vogue’s website teases an article with a link saying “Why Homeless Advocates Aren’t Happy With the 2020 Presidential Candidates” and an op-ed on radical labor organizing among nail salon workers.
Better health through better spaces
Even though lunch shaming, poor mental health, exhaustion and all sorts of other health problems still tragically afflict young people in schools, I am optimistic because it really does feel that the winds have shifted—thanks in large part to student activists, unhealthy schools are finally getting reforms they have long needed. As I argue at length in the book Philosophy of Population Health, health depends not just on whether we have good medical care, but also on whether the places where we live our everyday lives have been thoughtfully designed to support good health.
Sean A. Valles, PhD, is an Associate Professor with an appointment in Lyman Briggs College and the Department of Philosophy at Michigan State University. His research spans a range of topics in the philosophy of population health, from the use of evidence in medical genetics to the roles played by race concepts in epidemiology. He is author of the 2018 book, Philosophy of Population Health: Philosophy for a New Public Health Era. He is also Director of the MSU Science and Society @ State Program, supporting interdisciplinary faculty collaborations that join the humanities, arts, and sciences.
Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, November 28, 2019. With your participation, we hope to create discussions rich with insights from diverse perspectives.
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More Bioethics in the News from Dr. Valles: Recognizing Menstrual Supplies as Basic Health Necessities: The Bioethics of #FreePeriods; Trump’s Attempt to Reignite the Coal Industry Is Another Health Policy Blunder; Politics and the Other Lead Poisoning: The Public Health Ethics of Gun Violence; Climate Change and Medical Risk
References
- American Academy of Pediatrics. 2014. “Let Them Sleep: AAP Recommends Delaying Start Times of Middle and High Schools to Combat Teen Sleep Deprivation.” AAP.org https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Let-Them-Sleep-AAP-Recommends-Delaying-Start-Times-of-Middle-and-High-Schools-to-Combat-Teen-Sleep-Deprivation.aspx.
- Bote, Joshua. 2019. “California plans to end ‘lunch shaming’ with a new bill that guarantees meals for all students.” USAToday.com. Accessed 10/31/19. https://www.usatoday.com/story/news/nation/2019/10/14/california-signs-bill-end-lunch-shaming-meals-all-students/3972897002/.
- Hatzenbuehler, Mark L., Jo C. Phelan, and Bruce G. Link. 2013. “Stigma as a fundamental cause of population health inequalities.” American Journal of Public Health 103 (5):813-821. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682466/.
- Luna, Taryn. 2019. “California becomes first state in the country to push back school start times.” LATimes.com. Accessed 10/31/19. https://www.latimes.com/california/story/2019-10-13/california-first-state-country-later-school-start-times-new-law.
- Minges, Karl E., and Nancy S. Redeker. 2016. “Delayed school start times and adolescent sleep: a systematic review of the experimental evidence.” Sleep Medicine Reviews 28:86-95. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844764/.
- Simko-Bednarski, Evan. 2019. “Lunch debt policy in New Jersey school district sparks national attention.” CNN.com. Accessed 10/31/19. https://www.cnn.com/2019/05/12/politics/school-lunch-shaming-children-debt/index.html.
- Valles, Sean A. 2018. Philosophy of Population Health: Philosophy for a New Public Health Era. Abingdon, Oxon: Routledge.
- VanOrman, Alicia and Beth Jorosz. 2019. “Suicide Replaces Homicide as Second-Leading Cause of Death Among U.S. Teenagers.” PRB.com. Accessed 10/31/19. https://www.prb.org/suicide-replaces-homicide-second-leading-cause-death-among-us-teens/.
- Wolf, Zachary B. 2019. “The government already knows how to end school lunch shaming.” CNN.com. Accessed 10/31/19. https://www.cnn.com/2019/05/12/politics/school-lunch-shaming-children-debt/index.html.
- Wan, William. 2019. “Schools now letting students stay home sick for mental-health days.” WashingtonPost.com. Accessed 10/31/19. https://www.washingtonpost.com/health/schools-now-letting-youths-stay-home-sick-for-mental-health-days/2019/10/21/15df339a-e93b-11e9-85c0-85a098e47b37_story.html.
- Wikler, Maia and Thanu Yakupitiyage. 2019. “11 Young Climate Justice Activists You Need to Pay Attention To.” VICE.com. Accessed 10/31/19. https://www.vice.com/en_us/article/8xwvq3/11-young-climate-justice-activists-you-need-to-pay-attention-to-beyond-greta-thunberg.
- Witt, Emily. 2019. “From Parkland to Sunrise: A Year of Extraordinary Youth Activism.” NewYorker.com. Accessed 10/31/19. https://www.newyorker.com/news/news-desk/from-parkland-to-sunrise-a-year-of-extraordinary-youth-activism.
MSU Bioethics 
Hi! I’d be happy to chat here if anyone has comments or questions.
Hi Dr.Valles,
As a masters of social work student, I greatly appreciate these policies and the fact that students are advocating for policies that support their growth and development. I particularly find the information about trying to get “mental health days” to count as legitimate reasons to miss school interesting. I think back to my time in high school and talk about mental health was almost non-existent. While being able to take mental health days is great, I see an issue in the fact that students aren’t able to recognize what mental illness looks like, what symptoms are, and what to do if they’re experiencing mental health issues. I’m curious as to your thoughts about how schools can improve in this aspect, especially when social workers and psychologists in schools are already spread so thin?
Apologies for the delay. It seems that there was a technical problem with getting this reply to appear last night.
Thanks for these thoughtful comments and questions! I agree there’s a terrible shortage of mental health personnel, especially given the spike in need. I see there being two (partly overlapping) types of solutions that should be pursued simultaneously. Basically, we need both prevention and treatment, with an area of overlap that I think includes some harm reduction strategies (e.g. in the story, giving students with undiagnosed or untreated depression leeway to miss school once in a while). For treatment, we’re really stuck at a bottleneck due to there being too few professionals (and unevenly distributed—a lot of folks in rural areas are literally nowhere near the kind of professional care they need). We can try to make better use of existing resources, like expanding training for teachers, guidance counselors, etc. for recognizing symptoms and giving basic support/resources to folks in need. But the other piece is simply making society more conducive to mental health. In the US, we work/study too much, sleep too little, most of us live paycheck to paycheck (stressful!), and whatever is happening in politics is worrisome (to say the least). The prevention work will eventually need to deal with the problem of society being set up in a way that is uncaring toward most people, since we can only get so far by focusing on helping folks manage the symptoms of struggling with living in an uncaring world.
Dear Dr. Valles,
Thank you for this latest posting about the two newly passed laws in California, pertaining to middle school and high school students. It’s not often that we hear about laws being passed that benefit students, especially not older students. I am also in favor of passing these laws in Michigan and in other states. I agree that students going through stages of puberty require more sleep than adults do, and should be able to go to school later than 8 am, to avoid being overly tired, lacking sleep and attention, which causes more stress in a time where there’s more than enough with technology, standardized tests, college prep, social media, etc. I also agree that lunch shaming is a cruel act of almost bullying in a sense, and no, I can’t believe students that can’t afford lunches have to wear a stamp or band that shows everybody else! I am so glad to hear that is being banned in California, but with other states that allow it, it should be as well. Any sort of stigma, whether it be being from a poor family, or having a mental illness, should not be worn as a label.
It is really an exciting time of change in a sense, as more young people are banning together to form social movements, becoming activists, protesting and also speaking in public forums. It’s impressive to see so many young people get up there and speak for global warming and the impacts of gun violence on schools. I think it’s really incredible that students in Oregon and Utah worked on mental health days being legitimate sick days off from school, too. It’s an exciting time of positive change, but it is also a time of a lot of resistance to actually setting forth changes and listening to young people.
What interested you in mental health and middle and high school students in the first place? It looks like you are a research, involved in population health. What about your research or interest brought about the subject matter of changing school laws for the benefits of middle school and high school students specifically?
Thank you again for your blog!
Sincerely,
Jackie
Thanks for sharing all of this! I’m interested in youth/student health for a few reasons. First, I’m a teacher and I am so upset at seeing how many of my students are struggling with everything from depression to food and housing insecurity. They’re trying so hard to stay above water and they deserve better than that. Second, I’m a millennial and a parent, both of which seem to make me frustrated at the state of the world that is gradually being handed off to my generation and then on to my child’s generation. Third, it is pretty widely accepted in population health science literature that if we want to improve health in a population then ideally we should start young, to get kids on a healthy path, including trying to help healthy adolescents grow into healthy adults.
Thank you for the reply, Dr. Valles! I appreciate knowing some background as to why you’ve decided to go into this area of research. As a former elementary teacher working in title 1 schools, I have also witnessed and experienced how some schools are really understanding and on board with caring and improving health disparities among youth, versus those that are just perpetuating all the problems. I applaud you for your work that you do, and I am so happy to hear that you are getting the word out there through the blog posting, teaching and research work you are doing. I hope someday to take my elementary teaching background and recent social work experiences to get involved in improving health outcomes of youth that have faced adverse situations (and all youth in general in our new age), which in turn positively helps their academic, mental, physical, and emotional development. It is so sad to see that administrators and those high up don’t see the importance of holistic health education in schools, while students are still young! Because they are not getting that kind of education usually at home, or the media, or their peers.
Jacqueline
Hello! I am curious if you believe certain issues within schools are more important than others and should be advocated first. Some may believe that gun violence (or any violence) within schools should be addressed first. It would make sense to think that excessively early school starts wouldn’t be as important as addressing physical danger. However, it can also be argued that smaller issues within schools such as start time could contribute to the amount of violence we see within schools.
Thanks
Hello! I always enjoy a good priority-setting question. Though it’s always nice when it’s possible to not have to choose between different important things. And I think this is one of those cases where we don’t have to choose one over the other. The administrative processes of a legislature or school system changing the start time for a set of schools can and should happen in parallel to the separate process of changing social norms and laws regarding gun safety. The legal and social landscape on gun safety is complicated, and grassroots activism seems like it’ll be key to changing anything substantive. But we can work toward having rested students AND students safe from gunshot wounds. I think we need both of those things and more (fed students, students safe from bullying, students with comprehensive educations in sexual health, etc.). If your’e interested in the gun issue, I wrote a previous entry in this blog series about that topic. https://msubioethics.com/2016/11/17/public-health-ethics-of-gun-violence/
Hi Dr. Valles,
Thank you for your insightful posting on such a vital issue facing our country today. As a Master’s of Social Work student, the topics you discussed in this blog surrounding the overlap of income inequality and student health are extremely relevant to my realm of practice. I agree with you wholeheartedly that students should not be penalized or stigmatized on the basis of school lunch debt. Poverty and food insecurity are two topics that should not be taken lightly or scrutinized in learning environment for that matter. The effects that these two adversities can have on youth are very traumatic. Being “labeled” or made fun of in school for things outside of the student’s control can reinforce these negative feelings.
Therefore, I am a huge advocate for proposing policy changes in Michigan and other states in the country to mirror the work that California is doing. My question is, what can we do, as professionals in the field of mental health, medicine, or social science do to ensure student’s needs are being met at the ground level? How can we advocate effectively (much like many students have done for themselves already)?
That’s a great question, and a complex one. I could write about that all day, and have a lot to say about that topic in my book (cited above). But I don’t expect you to read my book. One practical first step, I think, would be to promote the Health in All Policies model that’s already been developed quite a lot. The most fundamental shift that’s needed, in a sense, is that we’re not thinking or talking about school start times, etc. as health issues. The Health in All Policies model gives guidance on how to make health part of the policy conversation and policy agenda when we’re discussing things that SEEM unrelated to health, but really are (school policies, tax reforms, public transportation system designs, and so on). There’s a nice guide for policymakers here, and I think it’s a cool resource to use in doing this kind of advocacy: https://www.apha.org/topics-and-issues/health-in-all-policies
Dr. Valles, Thank you for your informative post. I am also delighted that young Americans are advocating for themselves. The American Academy of Pediatrics and California state legislatures are not teenagers. The workers at these agencies are not actively in high school and observing the current demands of young Americans. With student advocates representing their population, the agencies will be able to determine relevant material to best assist with their needs. The new law for middle schools and high schools to start after 8:00 am is exciting! I currently have a fourth grader and live in Michigan. Middle school is approaching in the next couple year for us. Do you think Michigan will follow California’s new laws and change our schools start time for middle schools, if so when?
I’ve been thinking about my child and Michigan policies as well! I would love it if Michigan were to go in the same direction, but I think making any headway in Michigan would take some good outcomes in California. And, this is just a prediction since you asked about what I think will happen (or maybe could), I think the most likely way of getting this to move forward would be as part of a larger set of school reforms. With the growth of charter schools in Michigan, the state has sort of gone in the opposite direction of standardized start times–we’ve outsourced a big chunk of education management decisions to independent contractors. So my sense is that the political landscape in Michigan education is quite different than in California (with regard to how a school start time change would get received) in complex ways related to charter schools and generally how the state manages education. But that’s just my limited sense of the Michigan scene. See, e.g.: https://www.nytimes.com/2017/09/05/magazine/michigan-gambled-on-charter-schools-its-children-lost.html
Thank you for your feedback! I will look into the link you suggested.
Hello Dr. Valles,
I really enjoyed reading about all the different laws passed regarding healthier schools. I find it very encouraging to see students advocating for their needs. Even as a social work student, I find it inspiring how much these students are advocating for themselves and wanting to change the world we live in. Their advocacy will affect students for generations to come and hopefully continue a cycle of change. I find it very interesting that students in the New Jersey school district with lunch debt are unable to participate in extracurricular school activities. Like you said, as if being poverty isn’t hard enough, let’s put a target on certain students backs in order to make the situation worse. Thinking back into my high school days, extracurriculars would be a way for me to escape everything going on at home and I’m sure many other students feel the same way. Are you aware of any other states that have enforced this policy? How would you suggest that the community combat this new policy?
Hello! Thanks for reading and for the thoughtful questions! Yes, there are lots of schools doing versions of lunch shaming because of a combination of 1) they (apparently) think it’s acceptable and 2) they are within their powers to do so. I think fighting those policies in both ways could be effective. 1) By getting public attention to the fact that these (permitted) cruelties happening (the news stories seem to get traction because a lot of people find this unacceptable like I do. 2) Since I’d rather not put all of my trust in the ethical sensibilities of thousands of individual school administrators, I think it makes sense to advocate for laws like the California one that simply take away that option. I was just mentioning this in my MSU class last week and a student mentioned how their high school used lunch shaming, but the student had never put much thought into how unethical was until they heard it challenged. Change is possible.
Hi Dr. Valles,
Thanks so much for this blog post. I’ve been noticing many young activists coming forward and advocating for their own health and safety lately, and while I’m disappointed that they are having to do this for themselves I appreciate their strength and their tenacity. I also appreciate that you showed another way we can support their efforts—by sharing their work on any platforms we have that reach an audience. It’s also good to see that some people who are in power are listening to them! My school start time in high school was early and I remember my natural “clock” was set such that as I was finishing homework late at night I would dread having to get up in the morning to go. I can imagine in Michigan, where Daylight Savings Time doesn’t really help much during the winter months, that middle and high school aged folks feel similarly or may have an even worse time with sleep deprivation. Hopefully more states will get on board with later school start times, so that adolescents can get enough sleep to enable them to retain the information shared with them in the classroom (since we know sleep deprivation negatively impacts memory).
I know you mention that ideally, we would be able to build healthy spaces for our young people early on, but I’m wondering what ideas you have that could be implemented for our young people right now, in our current day? Obviously we need to increase resources available to them in a systemic sense, but in the meantime what can we do right now to mitigate some of this harm for young folks who likely will have left the school system by the time we enact some real policy change?
Thank you for sharing all if that. And I’m certainly a supporter of harm reduction strategies. In this case, I think two harm reduction strategies would be to implement much more local policies (school-level; or even just encouraging individual school employees to do what they can) for giving slack on “mental health days” and discouraging the use of shaming for unpaid lunch bills (or pretty much anything else in schools). Getting laws passed for either of those is a long-term project, but right now there’s a good amount of freedom for individual school employees to use their discretion. That creates opportunities.