Deliverable 06 - SMART Goals

Brief report

Journal of american college HealtH 2025, Vol. 73, no. 7, 2772–2776

A snapshot of the strategic priority of health and well-being at Historically Black Colleges and Universities: A brief report

tondra L. Moore, phD, JD, MpHa,b

aSchool of Public & allied Health, Prairie View a&m university, Prairie View, texas, uSa; bHealth Services, Student affairs, Prairie View a&m university, Prairie View, texas, uSa

ABSTRACT Objective:  this study provides an understanding of the strategic priority of health and well-being for students, employees, and the community at the 109 Historically Black Colleges and Universities (HBCUs) has been understudied. Methods:  Secondary data analysis of 89 publicly posted HBCUs’ strategic plans was used to identify institutional priorities regarding the health and well-being of students, employees, and the community. Results:  the data revealed 36% of HBCUs prioritized student health, 17% prioritized employee health, and 14%prioritized community health. An examination of the relationships between the existence of a strategic priority and the provision of health and wellness services demonstrated that having a strategic priority for students’ health and well-being was statistically significant for providing health services (80%), student counseling (87%), and recreational activities (75%), (α = .05, p = .001). Conclusions:  overall, health and well-being at HBCUs are underrepresented strategic priorities and are likely to impact the health and well-being services offered to support students enrolled at HBCUs.

Introduction

The landscape of educating African American scholars has become more dynamic over the past 150 years; however, the role of Historically Black Colleges and Universities (HBCUs) has remained unchanged in the academy. The first HBCUs began to emerge following the emancipation of enslaved Blacks in the United States during times of heightened racial segregation in southern states.1 HBCUs enroll only 9–10% of all African American students, yet they produce 20% of all African American graduates and 25% of African American STEM graduates.2 HBCUs also produced 40% of African American members of Congress, 12.5% of African American CEOs, and 80% of African American judges.3

Historically, black colleges and universities have served Black students from underserved communities and back- grounds who were unable to attend Predominantly White Institutions (PWIs).4 For these students, campus-based health and well-being resources serve as the sole source of primary care access and often act as safety nets for students who have little to no formal healthcare access. Post-COVID col- lege health and well-being leaders have made strides to posi- tion health and well-being as a strategic priority for higher education institutions. Some institutions have demonstrated a full campus priority by adopting the Healthy Campus Framework5 to bolster campus health and well-being efforts. With the dismantling of national health and well-being agencies, funding, and policies, institutions of higher

education will be required to identify strategies and resources to address the health and well-being needs of their campus community stakeholders.

An institution’s strategic plan aims to lead operations and demonstrate institutional priorities. As mentioned by EAB6 “Chief wellness officer positions have grown rapidly across the past few years due to the growth in appreciation for proactive well-being support and escalating demand for mental health services” (p. 2). As the importance of health and well-being increases, engagement with senior-level institutional leaders to position student and employee well-being as an institutional priority is critical to achieve a whole-campus approach to health and well-being. Therefore, strategic priority is essential.

There is little in the literature regarding health and well-being resources at HBCUs, and no data exploring the strategic importance of health and well-being at HBCUs. This study offers a snapshot of the strategic priority of health and well-being at HBCUs and the relationship to pro- viding health and well-being resources.

Methods

Using content analysis, strategic plan priorities and objec- tives were coded to identify a cross-sectional snapshot of institutional health and well-being strategic priorities. Conceptual analysis was also used to quantify offered health and well-being services on HBCU campuses. Institutional

© 2025 taylor & francis group, llc CONTACT tondra l. moore [email protected] School of Public & allied Health, Prairie View a&m university, Prairie View, tX, uSa.

https://doi.org/10.1080/07448481.2025.2539324

ARTICLE HISTORY received 14 april 2025 revised 2 July 2025 accepted 21 July 2025

KEYWORDS HBcu; strategic priority; health & well-being; Historically Black college & universities; health services; mental health

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website content referencing student support was coded to identify (a) a student health clinic, (b) student counseling services, (c) recreational sports or activities, (d) telehealth, and (e) student health insurance requirements. Plans dated to start in 2020 or later were coded as “post-COVID.”

Data

All federally recognized HBCUs were included in the sam- ple. Of all 113 HBCUs founded, 109 remain in operation, and 20 have no publicly posted strategic plan on the institu- tional website, leaving 89 strategic plans for review. Institutional websites were used to examine the presence of institutionally provided health and well-being resources for students.

Demographics

Of the 109 HBCUs, 89 had strategic plans publicly available on their institutional websites. According to the most recent enrollment data, HBCUs collectively enrolled 293,004 stu- dents in 2023.7 Among the 89 strategic plans, 49% were published after the onset of the COVID-19 pandemic. Additionally, 34% of the institutions in the study required students to maintain health insurance.

Health and well-being strategic priorities Selective reduction was used to code for a (1) strategic pri- ority of the health and well-being of students, (2) a strategic priority for the health and well-being of employees, and/or (3) a strategic priority of the health and well-being of the community. Community health and well-being were included, as some institutions had priorities that demonstrated a com- mitment to care for the community in alignment with the institutional mission. The mention of health and well-being programming and support indicated a strategic priority. Strategic priorities that only referenced enhancing or devel- oping health and well-being academic programs were not included.

The data were analyzed using IBM SPSS Statistics Version 28.0.1.1 (15). Cross-tabulation was performed as the data was coded to explore any relationship between the nominal variables. A chi-squared test of independence (p = 0.001) was conducted to examine the relationship between existing stra- tegic priorities (student health, employee health, community

health) and existing health and well-being services (student health, student counseling, recreational sports, telehealth, required student health insurance).

Results

Strategic plan priorities referencing health and well-being for students, employees, and the community, along with the fre- quency of health and well-being campus-based services, are provided in Table 1. The table also displays the results of potential relationships between the strategic priorities and the institutions offering health and well-being services.

Health and well-being services provided

Of 109 HBCU websites reviewed, 75 (69%) had content ref- erencing providing student health services, 86 (79%) refer- enced student counseling services, and 72 (66%) referenced some form of recreational services. Additionally, 30 (28%) had content referencing providing telehealth for physical and/or mental health services.

Strategic priority

Of the 89 institutional strategic plans reviewed, 52 (58%) were published following the onset of the COVID-19 pan- demic. Health and well-being appeared as strategic priorities in several plans, with 32 (36%) referencing student health, 15 (17%) referencing employee health, and 12 (14%) refer- encing community health.

Strategic priority for student health present

Among the 32 institutional strategic plans that prioritized student health and well-being, 13 (35%) were published post-COVID, a statistically significant finding (α = .05, p = .01). Further analysis of institutions that prioritized stu- dent health showed that 27 (84%) provided student health services, all 32 (100%) provided student counseling, and 26 (81%) offered some form of recreational activity. These find- ings were statistically significant (α = .05, p = .001). Only eight institutions (25%) that strategically prioritized student health and well-being (28%) required students to provide proof of health insurance, which was all statistically signifi- cant (α = .05, p = .01).

Table 1. HBcu strategic priorities and the provision of health and well-being services post-coViD.

HBcus Post-coViD

strategic plan Student health Student counseling recreation telehealth required student health insurance

HBcus 109 52 49% 75 69% 86 79% 72 66% 30 28% 37 34% Strategic Plans 89 82% 52** 58% 71** 80% 78** 87% 67** 75% 27 30% 34 38% Student SP 32 36% 13* 35% 27** 84% 32** 100% 26** 81% 10 31% 8* 25% Employee SP 15 17% 11** 73% 11** 73% 14** 93% 11** 73% 5 33% 5 33% Community SP 12 14% 7** 58% 9** 75% 11** 92% 10** 83% 3 25% 6* 50%

Shaded cells represent cross-tabular analysis results. SP: Strategic Priority Post-coViD, dated 2021 or later. *Significant at 0.01. **Significant at 0.001.

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Strategic priority for employee health present

Among the 15 institutional strategic plans that prioritized employee health and well-being, 11 (73%) were drafted post-COVID, a statistically significant finding (α = .05, p = .001). Further analysis of the institutions that prioritized employee health showed that 11 (73%) offered student health services, 14 (93%) offered student counseling, and 11 (73%) offered some form of recreational activity for students. These findings were statistically significant (α = .05, p = .001).

Strategic priority for community health present

Among the 12 institutional strategic plans that prioritized community health and well-being, seven (58%) were drafted post-COVID. Of these institutions, nine (75%) provided stu- dent health services, 11 (92%) offered counseling services to students, and ten (83%) provided some form of campus rec- reational activity. These findings were statistically significant (α = .05, p = .001).

Discussion

This study provides insight and sheds light on the current positioning of health and well-being services on HBCU campuses and in HBCUs’ strategic priorities. Due to the limited data about college health at HBCUs, it is critical that the college health and well-being landscape is examined and documented. Because the United States is at a precipice regarding the future of healthcare with unprecedented dis- ruptions of traditional healthcare data repositories, research funding, and federal agencies once dedicated to improving the health of underserved populations, institutions of higher education must strategize to address the future health and well-being needs of enrolled students.

Most of the 109 HBCUs, or 82%, have a publicly available strategic plan. Analyzing the data demonstrated that there is a possible relationship between having a posted strategic plan, if it was written post-COVID. Additionally, there appears to be a strong relationship between the existence of a publicly available strategic plan and providing on-campus health and well-being services to support student physical and mental health by providing on-campus services at HBCUs. Lastly, of the campuses with a student health and well-being priority, all provide student counseling services. While institutions with a strategic priority appear to be more proactive and responsive to student needs, attention is required for other campus stakeholders to achieve overall campus health.

As expected, most strategic plans prioritized student health and well-being over employees and the community. This could signal HBCUs focusing resources to support stu- dent needs in response to COVID-19 with the documented increased need for student mental health support at HBCUs.8 While HBCUs have historically provided resources to sup- port the greater community health and well-being needs,9 scarce resources and decreases in funding require

institutions to prioritize enrolled students, creating chal- lenges in fulfilling their once more altruistic missions.

College health professionals recognize the need to prepare for the next catastrophic health-related disruption in higher education.10 The rise in support for mental health post- COVID fails to recognize the importance of other aspects of health and well-being. The hyper-focus on mental health while ignoring other aspects of health creates a hole in the safety net. As HBCUs are mission-driven to serve a segment of the population that has traditionally been underserved, the lack of strategic priority for all health and sufficient resources remains a challenge at HBCUs. The current cli- mate in higher education calls for evidence to support decision-making. Therefore, HBCU leaders need data to substantiate the need for health and well-being to be strate- gic priorities and create the business case for institutional investment in bolstering campus health and well-being resources. With so little data available regarding the land- scape at HBCUs, institutional leaders and college-health pro- fessionals at HBCUs are at a significant disadvantage.

This study showed that the strategic priority of health and well-being at HBCUs is low, with only 36% of the exist- ing institutional strategic plans even referencing student health and well-being. While resources are one plausible explanation, another could be the lack of positional influ- ence for many college health professionals at HBCUs. Despite the national rise in executive cabinet-level health and well-being leaders in higher education, a parallel review of HBCU websites during this study revealed fewer than a handful of executive cabinet-level health and well-being offi- cers reporting to the President. This is noteworthy because without college health and well-being leaders systemically included in executive, cabinet-level discussions, the likeli- hood of new strategic priorities around health and well-being is grim. In a review of the rise of chief wellness officers in the US,11 highlighted that CWOs play a role in embedding a health and wellness strategic priority into an institutional strategic plan and “shaping a new well-being culture” (p. 145). As institutions begin to lose funding to support oper- ations, it is imperative that someone be positioned to ensure that health and well-being are a strategic priority when establishing institutional funding priorities. With fewer than five HBCUs designated as Healthy Campus Partners,12 this helps to validate the lack of health and well-being as a stra- tegic priority compared to other institutional priorities.

This snapshot of strategic priority and service delivery at HBCUs depicts a gloomy story for students’ health and well-being at HBCUs. Less than a third of HBCU strategic plans in the study prioritized student health and well-being. While only 32 (36%) of HBCU strategic plans prioritized student health and well-being, overwhelmingly, mental health is clearly a priority, with nearly 80% of all HBCUs offering mental health services. According to IPEDS (2025) data, 33% of existing HBCUs have an enrollment of less than 1,000 students.7 Therefore, it can be surmised that the level of services at HBCU institutions varies greatly. In fact, the review of HBCU websites revealed some institutions rely solely upon a single faculty member to provide students

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with mental health support. Regardless of the scope of ser- vices, the offering of services allows an institution to claim it offers services. Therefore, this study has to be framed as a high-level overview of the institutional strategic priorities and offering health and well-being services with more explo- ration regarding the levels of service, student outcomes, and institutional investments.

With the prospect of fewer external resources to support institutional operations, HBCU strategic leaders will be chal- lenged to consider the implications of failing to prioritize health and well-being while resources still exist. It is widely known that historically, HBCUs have been challenged because of historical and consistent underfunding, deferred maintenance, poor operating practices, and critical infra- structure needs.13,14 The challenges have caused operational priorities to be ranked higher, as reflected in the 89 strategic plans reviewed in this study. However, priorities for HBCUs must consider the instability of future federal and state sup- port, which has been critical since most HBCUs are public institutions. Therefore, it is critical to ensure HBCUs strate- gically include health and well-being as an institutional pri- ority to fortify institutions and improve the overall campus health and well-being.

The historical mission of HBCUs to serve and educate an underserved population of students continues to be critical as the nation experiences an unprecedented attack on higher education, health, and research. As these institutions have persisted despite years of underfunding, systemic racism, and reputation attacks, the tenets of HBCUs will prove to be the bedrock foundation that will allow them to weather the tough times. While the path traversed has been challenging, HBCUs eventually catch up to other institutions of higher education; however, it is imperative that HBCUs hasten to address health and well-being deficiencies to not fall too far behind, and this can best be done by strategically prioritiz- ing health and well-being.

Limitations

It must be noted that there are only 109 HBCUs, and all were included in this study; therefore, the generalizability of the data to other institutions may be limited. However, there are other institutions that face similar challenges due to enrollment size, geographical location, and/or serving other underrepresented populations. While the data focused on allowing college health professionals and campus leaders at HBCUs to understand the state of health and well-being pri- orities in relation to the level of support provided by the institution, other college health professionals may find com- parative models to address similar challenges.

Using websites to collect data could reflect missing, incorrect, or outdated information, thus failing to represent an institution’s health and well-being status accurately. Not all institutional websites provided a robust description of the health and well-being services provided. Although detailed descriptions of services, providers, paths to care, and student resources were provided on some websites,

others were scant, only providing a paragraph or less to communicate the existence of the health and well-being resource, with no other details. Therefore, some HBCUs may offer services not captured in this study because they were not explicitly listed on the website, while others may have mentioned services they no longer provide. Therefore, additional review is needed to analyze the scope of services and student outcomes.

Lastly, institutional strategic plans varied in timeliness, structure, and availability. Because some strategic plans were outdated, it was unclear if an updated strategic plan was in process but not yet published. Additionally, some strategic plans included extensive explanations, objectives, and met- rics, while others were less robust, with only the priorities listed. It is also plausible that some current institutional stra- tegic plans do not address health and well-being because of previous strategic plans may have addressed the needs, which are reflected in the current level of institutional sup- port for health and well-being. However, without a historical review of previous strategic plans, this cannot be offered as factual and leaves another possible avenue for future research.

The strategic priority of health and well-being of HBCUs has been used as a proxy in this study to help explain the landscape of health and well-being at HBCUs. More infor- mation and data are needed to fully understand college health and well-being at HBCUs, but this is a start.

Conflict of interest disclosure

The authors have no conflicts of interest to report.

Author contributions

Tondra L. Moore: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Visualization, Writing – original draft, Writing – review & editing.

Funding

No funding was used to support this research and/or the preparation of the manuscript.

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