Public schools have come under enormous pressure in recent years to demonstrate academic gains and to address deeply rooted disparities among students of different races, ethnic groups, and income levels. Clearly, boosting academic achievement should be a top priority. Less evident, however, is the long-term effect of supporting this goal by diverting attention and funding from programs that have traditionally supported student health and well-being. This study investigated how gains in test scores were related to three types of health-related barriers to student learning: (1) poor physical health indicators, such as lack of exercise and inadequate nutrition; (2) alcohol, tobacco, and other drug use (including use at school); and (3) violence, victimization, harassment, and lack of safety at school. Also investigated was how test scores were related to more beneficial influences on student well-being: (1) caring relationships; (2) high expectation messages; and (3) opportunities for participation and contribution. The study was conducted using longitudinal, school-level test-score data, as well as data from the state-sponsored California Healthy Kids Survey (a comprehensive student self-report assessment tool for monitoring the school environment, student health risks, and resilience assets. Also examined was whether or not student health risk and resilience were differentially related to changes in academic performance in low- and high-performing schools. Findings from this study suggest that efforts to improve schools should go beyond the current emphasis on standards and accountability measured by test scores. Policies and practices focusing exclusively on increasing test scores while ignoring the comprehensive health needs of students are almost certain to leave many children, and many schools, behind. These results have important policy implications for schools and stakeholders trying to meet accountability demands for improved academic performance. (Contains 11 figures.)