Worksite Health Interventions in Public Schools, Teacher Health, and Student Academic Performance

Project Summary

The project team leveraged existing data from an urban public school system in Tennessee to determine if locating a health clinic onsite and managing chronic conditions improved teacher health, retention, and productivity. The team also examined if this will in turn impact student academic performance.

Research Question(s)

  • Do worksite health interventions improve teacher health?
  • Does the health of teachers affect teacher retention and productivity?
  • Does the health of teachers impact student academic performance?


  • Inform the design and implementation of similar interventions across sectors through a better understanding of the associated costs and benefits.


School-based clinics reduce health care costs and illness-related absenteeism for teachers, but no significat differences were detected in self-reported health status or student academic achievement.

For teachers, using a school-based clinic rather than a community-based clinic for primary care was associated with significant reductions in:

  • Primary Care Visits (1637 vs 2756, per 1,000 teachers annually)
  • Inpatient Admissions (31 vs 53, per 1000 teachers annually)
  • Annual Health Care Costs ($4,298 vs $5,043 in 2016 US dollars)
  • Annual Absent Work Hours (61 vs 63)



Health: Health care utilization (inpatient admission, emergency room visits), total health care costs, biometrics (BMI, blood pressure, blood glucose, and cholesterol level), self-reported health status, job satisfaction, smoking status, physical activity, fruit consumption.

Other: Teacher retention, teacher absenteeism, student academic performance, teacher earnings, job performance score. 


An instrumental variable approach using the distance to the nearest clinic. A propensity score weighting method was applied for secondary analyses.

Teacher helping students at their desk
Grantee and Partner organizations

RAND Corporation
Continuance Health Solutions
Metropolitan Nashville Public Schools

Grant status
Principal investigators
Hangsheng Liu, PhD
John Engberg, PhD
Start date
Award amount
18 months

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