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Epidemiology and Education Research: Dialoguing about Disparities

by William F. Tate IV & Catherine Striley - June 23, 2010

We will argue in this commentary that epidemiology and education research as fields should engage in greater dialogue about pressing matters involving social disparities. Two questions will frame this commentary. What is epidemiology? How might this field inform our understanding of educational disparities?

Over the past two years, we have had numerous conversations about our fields of study—epidemiology and education research. More specifically, we have concluded that our mutual research and policy interests involving health disparities and education disparities are interdependent. A key risk factor in both education and health is residential segregation and the associated geographic concentration of poverty (Kramer & Hogue, 2009; Williams & Collins, 2001). Racial residential segregation is a fundamental cause of racial disparities in health. Segregation is a primary cause of racial differences in socioeconomic status (SES) where the key determining mechanisms are access to education and employment. Further, segregation creates conditions that are detrimental to health in the social and physical environment.  

Both the NCLB era (or the accountability movement more broadly) and the health disparities movement share a focus on eliminating unnecessary, preventable, and unjust social outcomes. Strikingly, the two movements are largely by way of custom, folkway, and institutional structures fairly described as systems in parallel play. Concentrated poverty makes a systemic disconnect between research on health and education as well as related policy analysis particularly disconcerting. Neuroscientists argue that brain development and cognitive functions are negatively influenced by environmental conditions associated with poverty (Farah, et al., 2006). The relationship between low-birth weight infants and cognitive deficits is well established. This relationship requires education systems to respond to students’ needs by requiring special education programs that cost more than regular education by a factor of 2 or 3. However, a model that takes seriously the interrelationship between education and health should not be limited to the very transparent matter of special education.

We will argue in this commentary that epidemiology and education research as fields should engage in greater dialogue about pressing matters involving social disparities. Two questions will frame this commentary. What is epidemiology? How might this field inform our understanding of educational disparities?  

Epidemiology is the study of the distribution and determinates of health-related states in specific populations and the application of this evaluative process to efforts to control health problems. Further, the objectives of epidemiology are fivefold (Gordis, 2009). The first objective of epidemiology is to determine the etiology of a disease and related risk factors. Studies with this objective have the potential to inform prevention programs. The second objective is to determine the extent of disease found in the community. The third objective is to investigate the natural history and prognosis of disease. The fourth objective is to study the efficacy and effectiveness of preventive and therapeutic measures and modes of health-related delivery systems. And the fifth objective is to inform the development of public policy related to environmental problems, genetic issues, and other issues related to disease prevention and health promotion.

A close examination of the definition and objectives of epidemiology suggests that the current accountability movement in education as well as the aim to reduce educational disparities would benefit from research where epidemiology is part of the portfolio of scholarship. This position is made more transparent by recent scholarship on school dropout. Breslau’s (2010) synthesis of the literature connecting health and high school dropout suggests that there are three distinct pathways with unique triggers: (1) childhood physical illnesses, (2) childhood and adolescent mental health problems, and (3) poor academic performance. While these triggers are different, each pathway is linked to the same shared educational outcome: increased risk for high school dropout. However, most accountability models and research efforts only examine the status of academic achievement or attempt to attribute achievement to school-related factors (teachers, schools, or programs). In addition, the third pathway provides insights into the role of academic performance on health. Although academic performance is widely studied and evaluated, the link with health is largely ignored by educators. All three pathways will be briefly discussed.

Historically, time-on-task and other opportunity to learn variables have been directly linked to academic achievement and indirectly associated with educational attainment (Berliner, 2007). Further, childhood physical illness is a very important pathway as chronic illness directly influences time-on-task and opportunity to learn. Many childhood physical illnesses can negatively influence education outcomes, including relatively prevalent illnesses, such as asthma and Type 1 Diabetes as well as less common illnesses, such as Sickle Cell Disease and Phenylkentonuria (PKU) (Breslau, 2010). These illnesses share a characteristic that influences education outcomes in that they all begin early in the life course and are already present when students first enter school. Moreover, children with these illnesses are not severely ill most of the time; long intervals of reasonable health states are combined with episodes of severe, often life-threatening events. Disparities in access to medical care are why these health conditions negatively impact education outcomes. These health conditions and many others (e.g., ear infections and dental problems) can be managed with existing medical treatments. There is no medical explanation for why any of these illnesses have negative educational effects. Despite being preventable, Breslau (2010) reported that one estimate indicated that in 2005, the 900,000 school-age children in California diagnosed with asthma missed about 1.9 million days of school, and poor children with the illness were more than twice as likely to miss a week or more of school as non-poor children with asthma. If time-on-task matters, then it is vitally important to better understand the links between health disparities and education outcomes. The childhood physical illness pathway represents a problem space where epidemiologic methods might inform our understanding of both health and education outcomes.

Buka, Monuteax, and Earls (2002) argued that the state of scientific insight generated as part of the epidemiologic study of child and adolescent psychopathology has grown considerably in the latter part of the twentieth century. They pointed out that much is known about the measurement, community study, prevalence, and risk factors for psychiatric disorders, particularly those of older children and adolescents. Evidence that mental health of children and adolescents is an area warranting attention by education researchers is well documented, however it is largely absent in discussions of educational disparities or equity. Epidemiologic studies suggest that nearly one-fifth of children ages 1-18 in the United States are in need of mental health services; half of these children have mental illnesses sufficiently severe enough to cause some level of impairment (Burns, et al., 1995). Unfortunately, despite high prevalence among pre-school and school-age children, only about 5-7% have received health services for their disability. Our conversations with school leaders suggest this is a significant problem in poor and racially segregated schools and communities.

Breslau (2010) argued that there are two distinct pathways linking mental health problems to education. The first pathway warranting furthering research involves children with inattention; a documented symptom of Attention Deficit Hyperactivity Disorder (ADHD), this symptom is linked to poorer performance on standardized achievement tests relative to peers. Poor academic performance in early grades increases the risk of school dropout. A second pathway involves externalizing behavior disorders in the early grades including oppositional defiant disorder and conduct disorder. Students externalizing behavior disorders are at greater risk of dropping out of school, being in trouble with the law, and having a poorer quality of life. However, contrary to expectation, many of these students do not underperform on measures of academic achievement. Research and evaluation that attends to these two pathways would be greatly enhanced if part of epidemiologic study.  

Epidemiology is the study of the distribution and determinates of health-related states. Distribution refers to incidence or prevalence of disorders in specific time periods. Determinates refers to risk factors for a disorder. To establish that some factor is a risk factor for a disorder, it must be demonstrated both that: (1) the factor precedes onset of the disorder, and (2) it is correlated with the disorder. If a factor is correlated with the presence or absence of a disorder in a cross-sectional study it may be a symptom of, or a result of the disorder, not a risk factor for it (Kraemer, 2010). We discuss time and cross-sectional studies as these issues are particularly relevant to the annual status reports associated with the predominant educational accountability models. These models do not take into account how risk factors emerge over time. Students initiate a wide range of behaviors that expose them to more risks for health and education-related problems. Some may assume that the pathway is unidirectional where risky behaviors (substance abuse or unprotected sex) cause underperformance in schools. However, Breslau (2010) concluded that the preponderance of evidence suggested the primary pathway connecting adolescent risk behavior and educational problems is the reverse direction. Risky behavior may indicate a student is already on an unproductive educational trajectory, rather than being a contributory cause of poor educational outcomes. This area of research and evaluation is another problem space where epidemiology may provide additional guidance and insight.   

The central argument in this commentary is that epidemiology and education research have for too long operated in a disjointed and disconnected fashion. However, there are important conceptual arguments (e.g., disparities) and mechanisms that suggest the need to engage in a more collaborative fashion. There are important problems that will require social scientists in both fields of study to examine more thoroughly the mechanisms that are influencing the distribution and determinants of important social outcomes. Indeed, unique opportunities exist for social scientists to move beyond parallel play toward more informed and sustained dialogues.


This commentary is based on work supported by the National Science Foundation under Award No. ESI-0227619. Any opinions, findings, and conclusions or recommendations expressed here are those of the authors and do not necessarily reflect the views of the National Science Foundation.


Berliner, D. C. (2007). Time to learn. Research Points, 5(2), 1-4.

Breslau, J. (2010, March). Health in childhood and adolescence and high school dropout (California Dropout Research Project #17). Santa Barbara, CA: University of California, Santa Barbara, Gevirtz Graduate School of Education.

Buka, S., Monuteaux, M., & Earls, F. (2002). The epidemiology of child and adolescent mental disorders. In M. T. Tsuang & M. Tohen (Eds.), Textbook in psychiatric epidemiology (pp. 629-655). New York, NY: Wiley-Liss.

Burns, B. J., Costello, C., Angold, A., Tweed, D., Stangl, D., Farmer, E. M., et al. (1995). Children’s mental health service use across sectors. Health Affairs, 14, 147-159.

Farah, M. J., Shera, D. M., Savage, J. H., Betancourt, L., Giannetta, J. M., Brodsky, et al. (2006). Childhood poverty: Specific associations with neurocognitive development. Brain Research, 1110, 166–174.

Gordis. L. (2008). Epidemiology (4th ed.). Philadelphia, PA: Elsevier.

James, S. A. (2009). Epidemiologic research on health disparities: Some thoughts on history and current developments. Epidemiologic Reviews, 31(1), 1-6.

Kraemer, H. C. (2010). Epidemiological methods: About time. International Journal of Environmental Research and Public Health, 7, 29-45.  

Kramer, M. R., & Hogue, C. R. (2009). Is segregation bad for your health? Epidemiologic Reviews. 31, 178-194.

Williams, D. R., & Collins, C. (2001). Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Reports, 116(5), 404-16.

Cite This Article as: Teachers College Record, Date Published: June 23, 2010
https://www.tcrecord.org ID Number: 16036, Date Accessed: 12/8/2021 9:03:14 AM

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About the Author
  • William Tate IV
    Washington University in St. Louis
    E-mail Author
    WILLIAM F. TATE IV is the Edward Mallinckrodt Distinguished University Professor in Arts & Sciences and Faculty Scholar in the Institute of Public Health at Washington University in St. Louis. He is a past president of the American Educational Research Association. His forthcoming book project is titled, Research on Schools, Neighborhoods, and Communities: Toward Civic Responsibility (Rowan & Littlefield).
  • Catherine Striley
    Washington University in St. Louis
    CATHERINE L.W. STRILEY PhD, ACSW, MPE is a Research Assistant Professor in the Epidemiology and Prevention Research Group, Department of Psychiatry, and the Associate Director of the Master of Psychiatric Epidemiology Program in the Washington University School of Medicine. She is currently the principal investigator on a community epidemiological study of the prevalence of Tourette Syndrome and Tic Disorders in minority populations and is a co-investigator on a nation-wide epidemiological study of nonmedical stimulant use among youth.
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