Lice.

I sat across from the school’s community relations person as she was discussing with me the No. 1 cause of absenteeism in her own local school. Her answer was a surprise, as I immediately failed to see how this could be such a burden on the school’s children.

I am one of the leaders of a community engagement initiative at Johns Hopkins called Medicine for the Greater Good (MGG). Over the years, our community partnerships have focused on headline-type health issues such as hypertension, smoking cessation and re-hospitalization. These issues are complex, and they require significant resources and engaged health care professionals with different levels of expertise.

So when I heard that lice were the main cause of absenteeism, I thought this could be a quick win for the local community.

I was wrong.

MGG conducted workshops at Baltimore City schools that self-identified as having lice issues and whose students missed dozens of days of school because of it. Despite the widespread nature of the problem, only eight parents attended our workshops. The stigma of being the parent of a child with lice was a clear barrier.

At these schools, a significant portion of the families affected by head lice are non-English speaking and found little information on the subject in their native language. When they did find information, it was confusing: It wasn’t clear how to properly use head lice medicine, where to buy it or how to prevent the spread of head lice.

Parents also made it clear that when you rely on public transportation, it adds to additional stress to the problem.

One mom told us that her son had lice and was removed from school on a Monday. Her job prevented her from getting home before 7:30 p.m., so she decided to pick up the medication on the weekend. However, on Friday, she was given the opportunity to work the weekend, which meant more income for her family. She grabbed the chance — not the lice medication. On the following Monday, she asked to leave her first job early to get her son’s medication. Unfortunately, the bus ran late and left her no time to pick up the medication before the start of her second job. She finally picked it up the following weekend.

Her son missed 15 days of school.

The cost of lice medication also came as quite a surprise to parents. One mother recounted that she was told the head lice kit cost under $5.

When she could only find one for $15, she had to consider spending the money on the medication or on several days’ worth of food.

The inability to respond to their children’s head lice did not culminate in mortality or economic health care burdens. It did, however, result in increased absenteeism from school, which poses its own threat in educational achievement.

MGG and I have been approaching the issue in collaboration with some Baltimore City schools and local communities. While the problem is still far from being solved, the long-term solution is advocacy: to identify homes that have lice infestations, to find cost-effective ways to eradicate these pests, and to highly encourage local school authorities to abide by the American Academy of Pediatrics recommendations that head lice should not result in absenteeism.

As a physician, I know that our hospitals are flooded with patients suffering from diseases that grab the headlines. But that doesn’t mean we should ignore those disparities that never make it to the emergency room. Head lice will never increase readmission rates or trigger financial penalties for a hospital, but it has a real impact on people’s lives.

To reduce disparities on every level requires aligning our health strategies to real community needs. This kind of engagement reaffirms medicine as a public trust. And that trust is essential for a community’s health problems — regardless of size and stigma.

Dr. Panagis Galiatsatos (panagis@jhmi.edu) is a physician and co-director of Medicine for the Greater Good.