Abstract
In this article Falconer et al. argue that the current levels of persistent absence in English schools represent a public health challenge with significant impacts for education, social and health outcomes. The piece introduces a new public health framework from the United States for tackling persistent absence and explores its relevance to the English context. It proposes practical strategies for adopting the public health principles outlined in the framework in England, highlighting the roles of key partners, including the NHS and Local Authorities.
School Attendance as a Vital Sign of Children’s Health
Since the pandemic, school attendance has plummeted on both sides of the Atlantic. Yet, school attendance is more than an education issue; it is a vital sign of children’s health and wellbeing. Like weight or blood pressure, it can signal emerging issues, guide early intervention and reflect how well systems are supporting children to thrive.
Despite its strong links to long-term health, employment and education outcomes, 1 school attendance has rarely been treated with the urgency or coordination it deserves.
In England, while there are signs of recovery from a postpandemic peak of 27% persistent absence (missing 10% or more of expected sessions) in 2021–2022, over 18% of pupils remain persistently absent, 2 a 64% increase from 2018 to 2019 (11%). 3 In the United States that figure is closer to 1 in 4. 4
School absence is especially high among pupils with health conditions, children receiving free school meals and those known to social care. Persistent absence often reflects wider unmet needs like chronic illness, mental health issues, housing instability or family trauma.5,6 These are public health issues. And they demand a public health response.
While England has largely framed this as a school-led challenge, a new framework in the United States offers an alternative: one that positions school attendance as a public health issue requiring collective, preventive action.
A Public Health Approach is Needed
In the United States, a new framework developed by Johns Hopkins University, Kaiser Permanente and Attendance Works, repositions school attendance as a public health issue and population-level challenge. 7 Although rooted in the US context, the framework’s core principles resonate with the UK’s own challenges and policy ambitions.
At its heart is a mindset shift: from viewing absence as an individual issue to tackling it through population-level prevention.
Principle 1: Use school attendance data as a vital sign of student and system wellbeing to drive action. It can signal emerging needs, guide early intervention and assess impact, especially when linked to health and social data.
Principle 2: Develop strategic partnerships to align goals and drive progress on chronic absence. Improvement requires coordination across education, health, public health and social care.
Principle 3: Develop strengths-based policies and programmes to prevent chronic absence and promote school attendance. Address root causes of absence such as housing, mental health and food insecurity through collective action.
Implications and Opportunities for the UK
In England, the Public Health Outcomes Framework recognises pupil attendance as a wider determinant of health, and statutory guidance calls for multi-agency working. 8 Yet, schools remain the lead and attendance efforts are typically managed within Education Services and assessed through school performance.
The current scale of persistent absence and its link to future outcomes demands shared ownership and integrated action. The US framework offers a practical alternative, inviting public health and the National Health Service (NHS) to play a more active role.
At a local level, Integrated Neighbourhood Teams (INTs) combining primary care, mental health, social care and community services offer a structure for impact. At a national level, future NHS plans should recognise school attendance as a key determinant of long-term health.
In practice, a public health approach to school attendance in England might include:
Including school attendance as a population health metric within local Joint Strategic Needs Assessments and Health and Wellbeing Strategies.
Integrated care systems (ICSs) aligning resources around shared priorities like asthma, mental health and obesity, particularly for children at risk of persistent absence.
INTs using school attendance data as an early warning sign to identify families in need, co-locate services in or near schools, support care coordination and simplify service navigation for families.
Local authorities improving the sharing of education and health data across sectors to better align priorities.
General practitioners (GPs) and paediatricians routinely asking about school attendance, especially in children with long-term health conditions (LTC). 9
Specialist community public health nurses (SCPHN) supporting school attendance both through individual interventions and population-level assessment of child health needs.
Parents and carers receiving timely support through trusted relationships and clear referral pathways.
Funders like NIHR recognising school attendance as a measurable health outcome.
Using school attendance as a measurable health outcome to promote cross-sector research on child health and wellbeing.
This shift would not replace schools’ roles but would complement them, ensuring other systems step up to share responsibility for helping children attend, thrive and succeed.
Conclusion
School attendance is not just an educational metric. It reflects how well our systems are working for children and families.
The US approach offers a useful starting point. Adapting it to the UK context and treating attendance as a vital sign of children’s health would mark a fundamental shift and bold step forward in promoting long-term child health and reducing inequalities.
The NHS and public health systems must step in, not just to support education, but also to help children and families thrive.
