College Student Health in the 21st Century

The first college student health services were developed in the early tomid-1800s. The Cadet Hospital was built by West Point in 1830 primarilyin response to respiratory illnesses that ran rife through the Academyeach winter.1 The hospital not only provided care for ill students but alsoallowed them to be separated from the general student population. Therole of similar infirmaries in preventing the spread of disease amongstudents was likely a primary driver of the development of college studenthealth programs in the 19th century. A more comprehensive model wasdeveloped by Amherst College in 1861 after the college presidentexpressed concern about the large numbers of students who had to leaveschool due to illnesses and observed that “students of our colleges havebodies which need care and culture as well as the intellectual and moralpowers and which need this care at the same time with higher educa-tion.”2 Amherst subsequently created the first physician faculty positiondedicated to student health; their program laid out a more comprehensiveapproach, as follows: (1) provide treatment of ill students, (2) providephysical examinations of all students when they arrive on campus, (3)conduct regular programs of physical exercise for students, and (4) pro-vide education in hygiene. This model of acute illness management, pre-ventive care through routine physical examinations, and health promotionthrough physical activity and education spread quickly.

By the early 20th century, most universities and larger colleges pro-vided medical care for their students. Since that time, college healthservices have altered their foci on the basis of the needs of their stu-dents, although change could be difficult. For example, in 1965, officialsat Columbia University, the University of Pennsylvania, the University ofMichigan, and others stated that their student health centers would notprovide contraceptives3; yet, by the 1980s, sexual health (particularlyregarding HIV) became a prominent focus.

College students in the 21st century continue to have shifting andexpanding health care needs. At the same time that many college healthservices have been hit by budget cuts and “outsourcing” of health care,the numbers of students with chronic health care needs entering col-lege have increased dramatically. At least 15% of incoming freshmanreport having a chronic health condition or disability,4 but the numberof college students with chronic health conditions is likely much higherbecause many young adults who have such conditions do not perceivethemselves as having “disabilities.”5 In this issue of Pediatrics, Lemlyet al6 describe the student health services available to youth withchronic medical conditions. Their results highlight a number of impor-tant issues for modern college health services.

Although the vast majority of colleges require immunization records,there is significant variability in other health-screening requirements,including medication review and physical examinations. Althoughmost student health directors believed that their institutions couldmanage asthma and depression on campus, only about half believed that

AUTHOR: Terrill Bravender, MD, MPH

Department of Pediatrics, University of Michigan, Ann Arbor,Michigan

KEY WORDSchronic medical conditions, college students, student healthservices

Opinions expressed in these commentaries are those of theauthor and not necessarily those of the American Academy ofPediatrics or its Committees.

www.pediatrics.org/cgi/doi/10.1542/peds.2014-2645

doi:10.1542/peds.2014-2645

Accepted for publication Aug 25, 2014

Address correspondence to Terrill Bravender MD, MPH, 1540 EastHospital Dr, Ann Arbor, MI 48109. E-mail: tdbrave@umich.edu

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2014 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE: The author has indicated he has nofinancial relationships relevant to this article to disclose.

FUNDING: No external funding.

POTENTIAL CONFLICT OF INTEREST: The author has indicated hehas no potential conflicts of interest to disclose.

COMPANION PAPER: A companion to this article can be found onpage 885, and online at www.pediatrics.org/cgi/doi/10.1542/peds.2014-1304.

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they could manage type 1 diabetes. Theauthors also found that only one-thirdof health services actively identifiedstudents with chronic conditions andthat even fewer reached out to studentsto encourage them to seek medicalcare.

Finally, although most student healthdirectors believed that their servicescould provide primary care to youngadults with chronic health conditions,very few were able to provide urgent

appointments on weekends or even-ings. It is likely that these limitationsare due to funding issues, which isunfortunate because college and uni-versity administrators should realizethat proper chronic illness manage-ment is not only good for studenthealth but also improves the educa-tional experience of students.

Thus, even if the health care needshave changed, the goals of studenthealth services remain the same in the

21st century as they were in the 19thcentury: improving general health toenhance education, retain students,and maximize graduation rates. As anadded benefit, student health ser-vices are in a unique position to helpyoung adults learn how to managetheir chronic conditions indepen-dently as they move from the pedi-atric to the adult health care world,improving what can often be a diffi-cult transition.

REFERENCES

1. Christmas WA. Campus-based college healthservices before the Amherst program(1860): military academies lead the way.J Am Coll Health. 2011;59(6):493–501

2. Tuner HS, Hurley JL. The history and de-velopment of college health. In: Turner HS,Hurley JL, eds. The History of Practice ofCollege Health. Lexington, KY: University ofKentucky Press; 2002

3. Prescott HM. Student Bodies: The Influenceof Student Health Services in American So-ciety and Medicine. Ann Arbor, MI: The Uni-versity of Michigan Press; 2007

4. Henderson C. College Freshmen With Dis-abilities: A Biennial Statistical Profile. Wash-ington, DC: American Council on Education;2001. Available at: http://files.eric.ed.gov/full-text/ED458728.pdf. Accessed August 21, 2014

5. Royster L, Marshall O. The chronic illnessinitiative: supporting college students withchronic illness needs at DePaul University.J Postsecondary Educ Disabil. 2008;20(2):120–125

6. Lemly DC, Lawlor K, Scherer EA, Kelemen S,Weitzman ER. College health service capacityto support youth with chronic medical con-ditions. Pediatrics. 2014;134(5):885–891

NO CAP ON As: How many A-level letter grades should be awarded in any givencollege course has been the subject of countless editorials and articles, withgrade inflation seeming rampant at all educational levels. In 2004, 50% of gradesgiven to Princeton students were A-levels. In response to that, the administrationcapped the number of A-level grades per course at 35%. University officialshoped that other schools would follow their lead, but few did. As a result, manyPrinceton students felt at a competitive disadvantage for jobs and acceptance tograduate programs. By 2009, the main source of unhappiness among Princetonstudents was the grading policy. Relief, however, is evidently in sight.As reported in The New York Times (N.Y./Region: August 7, 2014), the PrincetonUniversity President has endorsed a plan that allows individual academicdepartments to determine their own grading standards. While the plan stillneeds to be approved by the faculty, many are in favor, arguing that an arbitrarycap on A-levels does not work in anything other than large classes with hun-dreds of students. Students in small seminar classes are often unduly punished.Moreover, students feel they are competing against each other for a limitednumber of A-levels, creating unnecessary stress and unhealthy relationships.There certainly does not seem to be a right answer to grade inflation in ed-ucation. Capping the number of A-level grades seems arbitrary, and is certainlynot competency based. Still, one suspects that if Princeton adopts the new policy,the number of A-level grades will surely rise and once again we will have towrestle with the question: How many A-levels is too many?

Noted by WVR, MD

COMMENTARY

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