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Healthy Learners: A Whole Child Approach to Reducing Disparities in Early Education

reviewed by Sara Gable - October 11, 2016

coverTitle: Healthy Learners: A Whole Child Approach to Reducing Disparities in Early Education
Author(s): Robert Crosnoe, Claude Bonazzo, and Nina Wu
Publisher: Teachers College Press, New York
ISBN: 0807757098, Pages: 158, Year: 2015
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In Healthy Learners: A Whole Child Approach to Reducing Disparities in Early Education, authors Robert Crosnoe, Claude Bonazzo, and Nina Wu contend that preschool children’s health is an essential aspect of development and carries significant implications for early learning and school readiness. They introduce the idea of healthy learning as a primary goal for early childhood education (ECE) programs that prepare children for kindergarten. Healthy learning is defined as “the payoff to attending to health in ECE” (p. 4). The authors also advance healthy learning as a feasible strategy for reducing disparities in educational outcomes. With ongoing pressure to expand publicly funded high quality ECE programs and shifting demographics in the United States’ population of young children, the time is right for an educational approach that embodies the whole child.

The authors' primary focus of analysis is the children of Mexican immigrants, the most rapidly growing segment of the U.S. child population. Paradoxically, although health and educational outcomes for Mexican immigrants as a group are better than their socioeconomic statuses and life circumstances would suggest, this is not the case for preschool-aged children of Mexican immigrant parents. Accordingly, targeted efforts to improve the health status of this group of children, in combination with increased access to high quality ECE, have great policy potential.

To build their case, the authors utilize Crosnoe’s expanded school transition model (2006), originally proposed by Alexander and Entwisle (1988). Crosnoe’s reimagining integrates children’s immigration status (as a marker of stratification) and health (as a mechanism of stratification) to predict short- and long-term educational achievement and economic prosperity. A review of the research on health and education indicates a reciprocal relationship during all periods of development, with the exception of early childhood. During the years of early childhood, physical health plays a larger role in predicting educational outcomes than other experiences and setting factors (e.g., child care arrangements, socioeconomic status, race/ethnicity, etc.). In light of the noted early educational disparities for children of Mexican immigrant parents, the authors draw a blueprint for investigating healthy learning among their target population during the developmentally vulnerable period of early childhood and the transition to formal schooling.

With this extensive and well-researched background, Crosnoe, Bonazzo, and Wu present their mixed-method approach to studying child health and early learning among preschoolers with parents who emigrated from Mexico. Their quantitative analyses utilize the Early Childhood Longitudinal Study Birth Cohort (ECLS-B) for hypothesis testing. The qualitative analyses and data exploration use interviews that were conducted with Mexican immigrant parents, ECE teachers, and staff from a publicly funded pre-kindergarten program.

Preliminary descriptive analyses of the ECLS-B illustrate that children of Mexican immigrants have more general (versus serious) health problems when compared with young children from white, African American, Latino/a, and Mexican origin backgrounds. The early education experience and achievement comparisons show that children of Mexican immigrants have the lowest rates of participation in ECE programs prior to kindergarten entry. When comparing young children’s early academic abilities, the largest differences emerged between children with white parents and those with Mexican-born parents; children from other racial and ethnic minority groups scored somewhere between these two extremes.

Chapter Four, “The Links Between Early Health and Learning,” is very strong. Using the reimagined school transition model as its foundation, the chapter presents findings from structural equation models (SEM) of the relationship between Mexican immigrant status and school readiness at age four. In addition to examining direct relationships, the SEM approach also tests the mediating role of children’s physical health and cognitive skills at age two in explaining how immigrant status is linked with academics. The chapter includes a primer on the rigor of social science approaches aiming to find significant effects. This primer also serves to guide more in depth SEM analyses that introduce and use covariate sets, third variables, confounding influences, and unobserved factors when possible. The overall findings point to the accumulation of disadvantage from birth onward among children of Mexican immigrants (e.g., birth weight, maternal age, child care, and ECE arrangements at age two) as a significant predictor of prekindergarten differences in general health and measures of school readiness. The chapter concludes with questions for future research.

Chapter Five, “Mechanisms Linking Early Health and Learning,” reports findings from the qualitative interviews and focus groups with ECE teachers, staff, and parents. Unlike the previous chapter, it is exploratory in nature and employs a data-driven approach. Four broad themes emerge from this thematic analysis: a) family-school disconnect, b) teachers’ frustrations, c) mothers’ perspectives, and d) family-school miscommunication. Although this problem-focused approach yields some valuable insights, especially concerning ECE staff and parents’ views of child health in the early learning process, several shortcomings emerge. For instance, aside from two paragraphs on pages 22 and 23 and several notes, very little context about the schools (e.g., teacher education, compensation, and race/ethnicity) and the families and children (e.g., family size, parental education and employment status, and rates of child illness) is presented. Moreover, there is no acknowledgment that parents of Mexican origin who enroll their young children in formal ECE programs are embarking on a profound cultural shift. It has long been known that these families enroll their youngsters in ECE at far lower rates than other ethnic groups; Figure 3.2 on page 67 clearly shows this point. Recognizing this shift by integrating other relevant research and highlighting it in the qualitative analyses could have yielded new insights.

The penultimate chapter summarizes the physical health and early learning problems young children of Mexican immigrant parents face and discusses strategies to mitigate these issues. It includes a discussion of the numerous barriers families encounter when trying to access proper health care for their young children. The content addressing viable solutions is also quite extensive. For example, six promising practices appear that are drawn from a multi-state project by the Urban Institute that addresses low income immigrant families’ challenges in accessing health and social services. A section on supporting children with designated special needs is also included. The authors call for better integration of health-related services through the educational system (e.g., connecting silos) and more support for ECE teachers and parents to directly address the health concerns of young children. A particularly innovative approach proposes to support Mexican immigrant mothers’ attainment of formal education (“parents’ human capital,” pp. 115–116). Such a two-generation approach is reminiscent of the original ideals of Head Start.

Chapter Seven, “Looking Back and Moving Forward,” includes a useful overview and summary. It also further discusses and explores potential solutions and reflects on the original blueprint that guides the quantitative and qualitative studies found within.

This is a valuable and timely book that effectively makes the case for healthy learners as an optimal outcome of ECE programs. Although Healthy Learners focuses on the health and early education of children of Mexican immigrant parents, the message pertaining to physical health as an essential component of optimal development and well-being applies to young children from all backgrounds.


Alexander, K. L., & Entwisle, D. R. (1988). Achievement in the first two years of school: Patterns and processes. Monographs of the Society for Research on Child Development, 53(2), 1–157.   

Crosnoe, R. (2006). Mexican roots, American schools: Helping Mexican immigrant children succeed. Palo Alto, CA: Stanford University Press.

Cite This Article as: Teachers College Record, Date Published: October 11, 2016
https://www.tcrecord.org ID Number: 21678, Date Accessed: 5/21/2022 8:38:03 AM

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About the Author
  • Sara Gable
    University of Missouri, Columbia
    E-mail Author
    SARA GABLE is an Associate Professor and State Extension Specialist in the College of Human Environmental Sciences at the University of Missouri, Columbia. As a State Extension Specialist, she develops educational programs for early childhood professionals and assists with the Missouri Child and Adult Care Food Programís Eat Smart and MOve Smart initiatives. In partnership with a local Title I Preschool Program, she is working to discover new ways to teach young children about healthy eating and physical activity. She is conducting research to determine if physical activity can be integrated with number learning games to improve children's numeracy and is implementing a garden program for preschoolers to learn about the life cycle of plants and taste freshly harvested vegetables. Her first book, The States of Child Care: Building a Better System, was published in 2014 by Teachers College Press.
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