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November 14, 2023

It is surprising to learn that almost all successful programs and administrative interventions that increase students cognitive function and learning occur outside the classroom.  One of the most important opportunities is screening children for unrecognized health conditions that lower attendance and the student’s ability to learn when present.  Active intervention focused on these issues significantly increased learning, increased statewide ranking, and increases the praise of the parents, teachers, and school leadership.

When discussing student health, it is important to note that some school districts call their school nurse programs “School Nursing” and other school districts call theirs “School Health”.   The importance of this goes beyond the mere program title. To have a nursing program title implies that the job of  the nursing program is the delivery of care to those who are known to need it.  “School Health”  implies a much broader scope of work, including efforts to uncover threats to the healthy school environment, like indoor air pollution, lead in school drinking fountain water, or making efforts to identify students with unrecognized health conditions like pre-diabetes.

This broader emphasis on School Health is becoming extremely important in North Carolina schools because it is becoming clear that approximately one million of our school children have at least one unrecognized health condition that lowers their learning, as you can see in the table below.


Percentage of  the 1,442,736[i] North Carolina students with common unrecognized and untreated conditions that lower learning.

(School districts with high numbers of students from low income families have higher percentages than shown here, and some students may have 2 or more.)

Medical Condition

K-12 Prevalence

Number of N.C. students in 2022 student population with undiagnosed medical condition that lowers learning[ii]

25% [iii]




   288, 547





4-23%[vi] (using 10%)


Since 2019, many different reputable studies have ranked North Carolina per student state and local student funding somewhere between 45th –  51st out of all the states (includes Washington D.C.). For example, a 2022  analysis done by The Education Law Center found North Carolina state and local funding totaled $10,791 for each North Carolina student compared to the national average of $15,446 [vii]

 Screening students for invisible health issues that impact learning rests on the shoulders of school leadership, and the funds they need to do this do not exist.

One way they can cope is to recruit volunteers.

Reminding you of the information I shared last week: “Over half of all Americans over 55 years of age now declare themselves retired – 59 million people. [iii]  Of those, 48%  (28 million people) have at least a Bachelor’s degree.[iv]    On average, for every three K-12 students, one person over 55 years old with a bachelor’s degree is retired.  This is a key ingredient to increasing the positive trajectory of the medically undiagnosed student’s life.

Making invisible health conditions visible is complicated.

It is important that you understand that when attempting to make invisible health conditions visible there are some areas of potential mis-communication and misunderstanding.

The first is the use of the word “Screening”.   If you hear it used, ask the speaker to define their working definition.   This is often used to describe work done by a trained healthcare professional who uses their training, possibly including laboratory samples, and input from family members.    It would be tough to get enough volunteers with that kind of training.

However, before getting to the “Screening” stage, it is possible to do ‘mass surveys’.   During the mass survey, if a trained volunteer observes a child likely have a condition that lowers learning,  (like color blindness) the school system notifies the parent of the results of the survey and follows up with them and the school nurse to make sure the child receives the needed professional screening attention.

Many schools have successfully done ‘mass surveys” of their student population in the four health categories in the table above – and they usually reveal startling results and significant opportunities to Improve student learning  and school statewide ranking.

School systems have been performing various health ‘surveys’ for decades – and the entrenched methods are still dominating the process in spite of new electronic tools that do a better job faster.   I will introduce you to those tools as we drill down on the specific unrecognized medical conditions in future newsletters.

A school system’s effort to uncover hidden health conditions in students benefits more than just the student.  Lower statewide school ranking lowers property values for the homeowner, lowers tax income to the municipality, and results in less chance of the student gaining admission to a college or skilled trade school. Lives are altered – forever.

If you want to increase a school’s success, it is important to address all of the reasons it has been failing to improve its’ performance – not just the inside-the-classroom activity.

Now that you have a sense of the opportunity and the magnitude of the problem, how can we work together across the state to begin to address it?  I will give examples next week.





[iii] https://childrensvision.preventblindness.org/facts-about-childrens-vision/#:~:text=Vision%20disorders%20in%20children%20are,disorders%20remain%20undiagnosed%20and%20untreated.

[iv] https://www.audiology.org/wp-content/uploads/legacy/jama_lieu_2020_review%20article.pdf


[vi] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629936/

[vii] https://edlawcenter.org/research/making-the-grade-2022.html

My books containing other success stories

Written in 2015, this was my first attempt at celebrating successful actions taken by K-12 schools. Although the data is now outdated, the 22 concepts in this book are still valid, and worth a read. The website above will continue to add to that library – look on the right side for more recent role model stories.

We are living in an era when many Americans feel things are out of their control, which causes them frustration, anger, and depression. This book explains the theory and practice of how to influence the direction and growth of your local economy, and regain your power to protect your community and family. First published in 2016, the lessons remain accurate and powerful.

As a country, we are not without solutions. This collection, first published in 2013, takes a country-wide locally solvable view of significant issues which still exist, and in may ways have gotten worse since I first wrote about them. You, can solve these problems by imitating the behavior of the pioneer efforts cited here.

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Francis P. Koster Ed.D.

Proven local solutions to national problems.


Francis P. Koster, Ed. D.

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