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It’s All about Prevention: A Call for a National Health Education Test

I believe that strengthening school health and sex education programs should play a role in health care reform. A big national effort to prevent health problems like obesity, sexually transmitted diseases, unplanned pregnancy, smoking, and drug use among young people could do much to lower the ever-climbing costs of health care in America. To do this, we have to increase the emphasis on health education in our public schools. Presently it is a stepchild in the national curriculum.

The Senate Finance Committee should consider adding an amendment to the health care bill now under debate that would include an appropriation for the development of a national health education test for teens. Let’s call it, the National Health Education and Literacy Test. The ultimate goal would be for all students to pass the test sometime during high school in order to graduate.

Why does health education remain on the margins of the school curriculum, particularly when it has such potential for lifelong learning? I’ve always thought that the main reason why the subject resides in a sort of limbo is because students’ knowledge about health – as indicated in a standardized test – is not a requirement for acceptance to a university or college.

No state requires its students to pass a health education test in order to graduate high school. No student has ever been rejected from a college or university because he or she lacks knowledge about health issues.

If only Harvard would require all entering freshman to demonstrate basic health knowledge by passing a health literacy test, things might change — dramatically.

Suddenly, the school’s health education curriculum would come under close scrutiny; teachers would receive increased training; and kids would realize that health class really counts.

Health education would be moved from the back to near the front of the high school curriculum line. It would gain in stature. I am not guaranteeing that better health education and a health literacy test would result in 100-percent behavioral change, but sound knowledge is the first step in the process.

I decided to find out more about the possibility of developing a nationally standardized test in health education. A health educator referred me to Nancy Hudson, a senior associate at the Council of Chief State School Officers, in Washington, D.C.  She works for the Health Education Assessment Project (HEAP), whose mission is “to develop effective standards-based health education resources … to improve health literacy through improved instruction.”

When I asked Hudson about the availability of a national health literacy test, she e-mailed that “there is no national test, but we do have the technology to produce one through the Health Education Assessment Project.”

Her reply to my next question about the cost of creating such a test didn’t surprise me:

“Unfortunately, we do not have the funding or the staff to make this a reality,” she said and added, “We have over 1,900 assessment items to work with in constructing a test. We have the ability to develop and field-test new items; we would need to do that. We would need to construct the test instrument and test the instrument for validity and reliability.

“We would have to work to get national commitment, which would be a challenge in this environment (of skepticism about testing from some advocacy groups).”

Since I happen to live down the road from the Educational Testing Service – the national nonprofit institution known famously worldwide as the developer of the SAT (Scholastic Aptitude Test) and other educational products – I decided to gather more information about the cost of developing a national test.

I carried my search to Tom Ewing, ETS’s Director of External Relations. He lead me through the steps of developing and piloting a health education test specifically for New Jersey high school students rather than conjecturing about developing a national test. His bottom line is that it would take $250,000 and 18 months to develop a standardized health education/literacy test for New Jersey public school students and that it could be done with the necessary funding.

Knowing that 1,900 test items exist for a national health education test and that the cost for one state to create and pilot such an instrument would be around $250,000, let me suggest an amendment for consideration by senators who are marking up several health care reform bills.

It would set aside an appropriation of a million dollars to create a national health education test and pilot test it in four states in different parts of the country. The results of the pilot could be a wake-up call about what our young people know and do not know about health issues and the work that lies ahead to help them gain knowledge to prevent medical problems as they age.

My next step is to e-mail this column to New Jersey Senators Robert Menendez and Frank Lautenberg. If you think developing a National Health Education and Literacy Test is a good idea and should be incorporated into health care reform, let them know. You can reach them through their websites, and

In the meantime, Harvard, it’s up to you.

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