Health Equity, Schooling Hesitancy, and the Social Determinants of Learning

At least 25 million K-12 students in the U.S.—disproportionately children of color from low-income families—have been physically out of school for a full year due to the COVID-19 pandemic. These children are at risk of significant academic, social, mental, and physical harm now and in the long-term. We must determine how to help all students gain access to safe, in-person schooling. In this interdisciplinary Viewpoint, we review the literature about the association between school reopening and COVID-19 transmission rates, and about the political, social, and environmental conditions that shape families’ and teachers’ choices to return to in-person schooling. Even though schools can safely be opened with appropriate mitigation measures, we find four reasons for schooling hesitancy: high community transmission rates; the Trump administration’s politicization of school re-openings in Summer 2020; long-term histories of mutual mistrust and racialized disinvestment in urban districts; and rational calculation about vulnerability due to the social determinants of health that have led Black and Latinx parents disproportionately to keep their children at home and White families disproportionately to send their children to school. Given the deep interconnections between the social determinants of health and of learning, and between schooling hesitancy and community vulnerability, stark inequities in in-person schooling access and take-up are likely to persist. In addition to ramping up safe and speedy school reopening now, we must make a long-term commitment to supporting schools as both sites of and contributors to public health, especially in historically marginalized communities.