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When a child misses school again and again, the first question is usually asked in the classroom: what is going on with this student? A publication released on 29 October 2026 suggests that the better question may need to be asked in two places at once: the classroom and the clinic. Chronic absenteeism, the publication argues, is not only an education problem. It is also a public health concern, and the places making progress are the ones where health agencies and schools are learning to work from the same set of numbers.
The publication comes from Child Trends, a research organisation, and it is built around conversations with two public health leaders: Ryan Skaggs, who works with the California Department of Health, and Clarie Miller, who works with the New Mexico Department of Health. The two leaders describe how they use chronic absenteeism data to understand young people’s health needs and how they work with the education sector to improve student health and support attendance. The piece is short, and it does not pretend to be a manual. Its value lies in the shift of perspective it describes: attendance data, read through a health lens, can reveal needs that a school register alone might miss.
The number that frames the problem
Chronic absence has a specific definition, and it is worth stating plainly because much confusion comes from mixing it up with truancy. A student is chronically absent when they miss 10 percent or more of school days in a year. Unlike truancy, which concerns unexcused absence, chronic absenteeism covers both excused and unexcused absences. A child who misses school because of repeated illness counts just as much as a child who misses school for any other reason, because the lost learning time is the same either way.
The scale of the problem in the United States is large. The United States Department of Education has noted that 20 states reported that more than 30 percent of students missed at least three weeks of school in the 2022-2023 school year. More recent findings from the American School District Panel and American Youth Panel, run by RAND and the Center on Reinvesting in Public Education, have estimated that about 22 percent of students, or 10.8 million students, were chronically absent in the 2024-2025 school year. Those figures, set out in the Child Trends publication on health agencies and schools, explain why attendance has become a top concern for so many districts at once.
There is a second reason the numbers matter. The exact cut-off for chronic absence differs across the country because the number of instructional days varies from state to state. A 10 percent threshold means something slightly different in a state with 170 school days than in a state with 180. That variation is one reason shared work between health and education agencies is complicated: partners must first agree on what they are counting before they can agree on what to do about it.
Why health belongs in the attendance conversation
The link between health and attendance runs in both directions, and the publication lays out the chain clearly. Students often miss school because of a health concern. Students with chronic health conditions, and students in generally fair or poor health, are more likely to cite their health as a reason for missing school. Health-related absences can also fall unevenly: for example, Hispanic students and White students were more likely than Asian and Black students to be chronically absent because of health in 2022, and students experiencing greater poverty in a given year were more likely to experience chronic absenteeism because of health during that same year.
The chain runs the other way too. Missing a lot of school can affect academic achievement, including on-time graduation from high school and enrolment in higher education. And educational attainment is itself linked to future health outcomes. In other words, poor health can lead to missed school, missed school can lead to lower attainment, and lower attainment is associated with poorer health later in life. It is a loop, and breaking it requires action at more than one point.
That loop is the strongest argument for partnership. A school can see that a student is absent, but it may not see the asthma flare-ups, the dental pain, the anxiety or the untreated vision problem behind the absences. A health agency can see the pattern of health needs in a community, but it may not see which schools and which age groups are most affected. Put the two views together and the picture sharpens: a neighbourhood with high rates of a particular health problem and high absence rates in the same schools is telling both agencies something neither could see alone.
Two states, two ways of working
The publication draws on experience from two very different states, and the contrast is instructive even though the piece itself is built around a video conversation rather than a detailed programme manual.
California: reading attendance data for health needs
In California, the public health perspective described by Ryan Skaggs centres on using chronic absenteeism data to inform an understanding of young people’s health needs. The emphasis is on interpretation: attendance figures are not treated as a final verdict on a school, but as a signal that can point health officials towards the places and populations where support is most needed. A district with rising absence among younger children, for instance, raises different health questions than a district where absence spikes in the upper grades. The data does not answer those questions by itself, but it tells officials where to start asking.
New Mexico: connecting health work with the education sector
In New Mexico, the work described by Clarie Miller centres on how a health department works with the education sector in practice. The emphasis here is on the relationship itself: shared understanding, shared language and a willingness to act on the same numbers. Health agencies and schools have different mandates, different funding streams and different professional cultures, so a partnership that looks obvious on paper can still fail in practice if neither side understands the other’s constraints. The New Mexico experience, as presented, is a reminder that collaboration is a skill to be built, not a meeting to be held.
What the two stories share
Despite their differences, the two accounts point in the same direction. Both treat attendance data as a starting point for joint work rather than as a report card for one side to judge the other. Both recognise that health-related absence has causes that schools cannot fix alone, and that schools hold information health agencies cannot gather alone. And both suggest that the partnership works best when it is regular and practical, not a one-off response to a crisis year.
A step-by-step partnership playbook
Drawing on the themes of the publication, here is how a health-school partnership on attendance can be built in practice. These steps are general guidance for districts and agencies, not a description of any single state’s programme.
Step 1: Agree on the definition first
Settle what counts as chronic absence in your context before comparing numbers. Confirm the 10 percent threshold, the number of instructional days, and whether excused and unexcused absences are both included. A partnership that argues about definitions every quarter will never get to the work itself.
Step 2: Share the data in both directions
Schools share attendance patterns by grade, school and student group. Health agencies share what they know about health needs in the same communities: where services are thin, where particular conditions cluster, and where families face barriers to care. Each side’s data makes the other’s data more useful.
Step 3: Look for patterns, not just totals
A district-wide absence rate hides the story. Break the numbers down: by age group, by school, by time of year, and by whether absences cluster around particular health issues. A spike in autumn may point to something different from a steady year-round drift, and the response should differ accordingly.
Step 4: Coordinate the response, not just the analysis
Agree on who contacts a family, what support is offered, and how the school and the health service avoid duplicating each other’s outreach. Families dealing with a child’s health problem do not need two separate systems asking them the same questions. One coordinated conversation, with the family’s consent, is worth more than two parallel ones.
Step 5: Review together, and say what changed
Return to the same numbers after a term or a year and review them jointly. Did absence fall in the schools where support was concentrated? Did it fall for the groups the partnership aimed to help? Honest joint review is what turns a partnership from a launch announcement into a routine way of working.
What families can notice at home
For parents, the publication carries a practical message that does not require any agency partnership at all: absence is worth tracking, and health-related absence is worth understanding rather than simply recording. A child who misses school repeatedly for the same health reason is telling the family something, and the earlier that pattern is recognised, the easier it is to raise with a school nurse, a teacher or a clinician.
Keeping a simple monthly record helps. Note the dates missed, the reason given, and whether the same reason recurs. Over a term, that record shows whether absences are scattered or clustered, and whether they are rising or falling. The site’s monthly attendance tracker guide explains how to keep such a record in a straightforward way, and the guide to calculating the absenteeism rate sets out the arithmetic behind the 10 percent threshold in plain terms. Families who want the figure worked out for them can use the absenteeism rate calculator.
Two cautions belong here. First, a home record is a conversation starter, not a diagnosis: recurring health-related absence deserves a conversation with a health professional, not a conclusion drawn from a spreadsheet. Second, the goal is support, not surveillance. A child who knows their absences are being counted with care, and who is asked what would help them attend more regularly, is more likely to engage than a child who feels monitored.
Where the limits are
A careful reader should also note what the publication does not claim. It does not claim that health partnerships alone will solve chronic absenteeism, and it does not offer a single proven model that every district can copy. Chronic absence has many drivers beyond health: transport, housing instability, caring responsibilities, disengagement from school, and, in some communities, fear linked to immigration enforcement, which has been noted in wider reporting on the issue. A health partnership addresses one important part of the picture, not the whole of it.
Data limits matter too. Attendance data can show where absence is concentrated, but it cannot by itself show why a particular child is absent. That requires conversation with the family, handled sensitively and with appropriate privacy protections. Health data and school data are both sensitive, and sharing them across agencies must be done within the rules that protect students and families. A partnership that rushes past those protections will lose the trust it needs to work.
Finally, national figures should be read with care. A 22 percent national estimate for 2024-2025 and a 20-state figure for 2022-2023 come from different sources and different years, and state definitions vary. They establish that the problem is large and widespread; they do not, on their own, rank one state against another or prove that any single intervention caused a change.
What happens next
The most interesting question raised by the publication is whether health-school partnerships will move from promising examples to routine practice. The ingredients are now visible: a shared definition, data shared in both directions, pattern-spotting rather than headline-watching, coordinated family outreach, and joint review. What is less visible, so far, is how many districts and health departments have adopted all five together, and how consistently the approach survives changes in leadership and funding.
For educators and health officials, the next step is practical rather than theoretical: pick one shared measure, one joint review date, and one group of students to focus on first, and learn from that small, concrete collaboration before scaling it. For families, the next step is simpler still: keep a monthly eye on attendance, notice patterns early, and ask for help while a small problem is still small.
Questions readers are asking
What counts as chronic absenteeism?
A student is chronically absent when they miss 10 percent or more of school days in a year. It covers both excused and unexcused absences, which is what distinguishes it from truancy.
How many students are chronically absent in the United States?
Findings from the American School District Panel and American Youth Panel by RAND and the Center on Reinvesting in Public Education estimated that about 22 percent of students, or 10.8 million students, were chronically absent in the 2024-2025 school year.
Why should health agencies care about school attendance?
Students often miss school because of health concerns, and students with chronic health conditions are more likely to cite health as a reason for absence. Missing school can affect achievement and graduation, and educational attainment is linked to future health, so health and education form a loop that both sectors have a stake in breaking.
What do California and New Mexico bring to this discussion?
The Child Trends publication features public health leaders from the California Department of Health and the New Mexico Department of Health, who describe how they use attendance data to understand young people’s health needs and how they work with schools to support attendance and student health.
Can a family track chronic absence at home?
Yes, in a simple way: record days missed each month, divide by the number of school days, and compare the result with the 10 percent threshold. A rising pattern, or repeated absence for the same health reason, is worth raising with the school and, where health is involved, with a health professional.
Parents and educators who want a quick check can work out the figure with the attendance percentage calculator on this site, and revisit it monthly through the school year. Attendance, after all, is not a statistic to be quoted once a year. It is a daily habit, and the partnerships that protect it best are the ones that notice early, share what they know, and act together.
