Redefine health less as a state of well-being, more as a dynamic accumulation of resources, and the relationship between children's health and their education outcomes can be seamless, Children’s Hospital of Philadelphia pediatrician Chris Forrest told a US conference of quality of life experts, last week.

Much of the discussion at the New Orleans meeting focused on the value and versatility of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) as an international measure. And, at an earlier session, Harvard public health specialist Joshua Salomon described how it had accommodated a fruitful shift toward subjective assessment of well-being.

But Forrest said that the distinction the ICF continued to draw between biological, physical and social aspects of health was counterproductive in the new climate, because it maintained a status quo in which the focus was on ill-health and disease rather than on what it meant to be healthy.

Beginning in the 1990s, Forrest's team has been developing a new conceptual framework for measuring children’s health and illness. It speaks of health as a set of assets and resources that children can draw upon for healthy development and for overcoming whatever adversity they face. 

He was reporting preliminary findings from a study, Healthy Pathways to Success, that has been observing the relationship between positive health assets, school achievement and later physical and emotional stress. The work was funded by the US National Institutes of Health.

Under scrutiny were three inter-related types of health assets. First was vitality children’s zest, energy and engagement with physical activity bolstered by their diet and adequate sleep; second, adaptability children’s ability to regulate their emotions and thoughts and cope with adversity; third,connectedness children’s ties to positive and supportive family members, peers and members of their social environment.

In 2005, Forrest’s team started collecting health and school achievement data from over 2,000 children in Grades four to six (between the ages of nine and 11) from three diverse areas of Maryland and West Virginia.

The children were followed up over three years to see how important vitality, adaptability and connectedness had turned out to be in predicting how engaged children were at school and how far they influenced academic performance. 

Preliminary results suggested that a greater number of positive health assets was strongly predictive not only of children’s later physical or emotional distress, satisfaction with their lives and whether or not they engaged in risky behavior, but also of greater engagement with school, higher scores on standardized achievement tests and better grades. 

Project Healthy Pathways also uncovered evidence that for about 12 per cent of the children, their bank of positive assets steadily declined over time. For the majority those internal resources remained stable; those with consistently few positive assets were at greater risk of physical and emotional distress, demonstrated poorer engagement and achieved poorer grades. 

“The logical place to start,” he said, “is with those children with consistently low numbers of assets and those with declining assets”. His team intended to find out more about such children and which assets played a critical role in determining academic outcomes – and to use the combination of findings to inform interventions to boost the positives.