Health, Education and the Welfare of the Nation

We know that health, education and poverty are linked. This is why, at one time, the U.S had a Secretary of Health, Education and Welfare. Restoring that cabinet post might go a long way toward inspiring discussion about how to approach all three simultaneously. By viewing them as separate problems, we “see” only one part of the elephant. With that in mind, I have decided that, from time to time, HealthBeat should look at ideas for educational reform.

The facts about the connection between education and health are grim. A year ago the Congressional Budget Office (CBO) issued a report titled “Growing Disparities in Life Expectancy” which revealed that “the gap in life expectancy at age 25 between individuals with a high school education or less and individuals with any college education increased by about 30 percent” from 1990 to 2000. The gap widened because of increases in life expectancy for the better educated group,” the report notes. “Life expectancy for those with less education did not increase over that period.”

People with less education also are m ore likely to suffer from the disease many of us dread most, the scourge we call “Alzheimer’s.” A 2008 study published in the medical journal Neurology  reveals those with at least 15 year of education have a “cognitive reserve” of extra neural connections, which allows their brain to handle more plaques and tangles without showing Alzheimer symptoms. Conversely, according to a 2007 study from Finland, “people who don't finish high school are at a higher risk of developing dementia and Alzheimer's disease compared to people with more education regardless of lifestyle choices and [other] characteristics.”

Finally, those with less education are far more likely to smoke, and less likely to be able to help manage a chronic disease-- more likely to become confused about medication, to miss medical appointments, and to forget to take needed drugs.

1980 to 2000 –Growing Disparities

During the final two decades of the twentieth century you can draw a straight line connecting growing poverty, especially among children, a deteriorating educational system, and poorer health. When the CBO broke down life expectancy statistics by socioeconomic group, it discovered that: “In 1980, life expectancy at birth was 2.8 years more for the highest socioeconomic group than for the lowest. By 2000, that gap had risen to 4.5 years.”

What changed after 1980? A recent study published in PLoS Medicine goes back to the 1960s to compare what happened in the 1960s and 1970s to what happened in the two decades that followed. What the authors discovered is shocking: “ from 1960 to 1980, life expectancy increased everywhere” in the U.S.. But “beginning in the early 1980s the differences in death rates among/across different counties began to increase.” (The study looked at counties because they are the smallest geographic units for which death rates are collected, thus allowing for a precise comparison of subgroups) “The worst-off counties no longer experienced a fall in death rates,” the researchers observed. Instead,“in a substantial number of counties, mortality actually increased, especially for women…”

1980 was the year that a conservative agenda firmly replaced the “War on Poverty” that LBJ had begun in the 1960s. (Not coincidentally, this is also the year that the Department of Health, Education and Welfare disappeared.) For the next 28 years, the trend would continue as corporate welfare and tax cuts for the wealthy replaced programs for the poor and middle-class.

As the authors of the PLoS Medicine study note, “in the 1980s there was a general cutting back of welfare state provisions in America, which included cuts to public health and antipoverty programs, tax relief for the wealthy, and worsening inequity in the access to and quality of health care.” By contrast, in the 1960s, “civil rights legislation and the establishment of Medicare set out to reduce socioeconomic and racial/ethnic inequalities and improve access to health care.”

After 1980, the study observes rates of premature mortality across socioeconomic groups began to diverge, helping to roll back the gains of the 1960s and 1970s. In a stunning conclusion, the study’s authors report that “if all people in the US population experienced the same health gains as the most advantaged [i.e. whites in the highest income group] without the problems of the 1980s, “14 percent of the premature deaths among whites and 30 percent of the premature deaths among people of color would have been prevented.”

Investments in Education Slow

During the 1960s, government invested in programs like “Head Start” and serious efforts were made to provide poorer students with equal educational opportunities including generous scholarships based on need; these grants allowed many to become the first in their families to attend college. By contrast, in the 1980s and 1990s, loans for upper-middle class families replaced scholarships for the poor, investments in public education slowed, many lost faith in urban public schools, and those schools deteriorated.

As President Obama pointed out in his speech on education earlier this week: “despite resources that are unmatched anywhere in the world, we've let our grades slip, our schools crumble, our teacher quality fall short, and other nations outpace us. Let me give you a few statistics. In 8th grade math, we've fallen to 9th place. Singapore's middle-schoolers outperform ours three to one. Just a third of our 13- and 14-year-olds can read as well as they should. And year after year, a stubborn gap persists between how well white students are doing compared to their African American and Latino classmates. The relative decline of American education is untenable for our economy, it's unsustainable for our democracy, it's unacceptable for our children -- and we can't afford to let it continue.”

Recognizing the link between education and health, the president talked about the important of early childhood education—and good healthcare from the very beginning: “Studies show that children in early childhood education programs are more likely to score higher in reading and math, more likely to graduate from high school and attend college, more likely to hold a job, and more likely to earn more in that job. For every dollar we invest in these programs, we get nearly $10 back in reduced welfare rolls, fewer health care costs, and less crime. That's why the American Recovery and Reinvestment Act that I signed into law invests $5 billion in growing Early Head Start and Head Start, expanding access to quality child care for 150,000 more children from working families, and doing more for children with special needs. And that's why we are going to offer 55,000 first-time parents regular visits from trained nurses to help make sure their children are healthy and prepare them for school and for life.”

After discussing programs designed to raise standards in public schools, recruit and reward excellent teachers, and encourage innovation, the president ended his speech by pledging to make college affordable for 7 million more students : “Because rising costs mean Pell Grants cover less than half as much tuition as they did 30 years ago, we're raising the maximum Pell Grant to $5,550 a year and indexing it above inflation. We're also providing a $2,500-a-year tuition tax credit for students from working families. And we're modernizing and expanding the Perkins Loan Program to make sure schools like UNLV don't get a tenth as many Perkins loans as schools like Harvard.

“To help pay for all of this,” he told his audience, “we're putting students ahead of lenders by eliminating wasteful student loan subsidies that cost taxpayers billions each year.”

These are all excellent ideas. But, as The Century Foundation’s Richard Kahlenberg pointed out in a recent blog, one element is missing: “the need to attack the fountainhead of unequal schooling:  our system of educating low-income and minority students separately from middle-class and white students. . . ., why not address this question head-on?

“Of course,” Kahlenberg added, “Obama is rightly leery about being associated with the old notion of compulsory busing from the 1970s, which was politically toxic and in many cases was counterproductive, feeding white flight.  But he recognized in his famous speech on race during the campaign that segregated schools are still unequal, and there are lots of examples of highly successful school integration programs that are voluntary and politically popular.

Here Kahlenberg goes on to talk about programs that takes children out of the ghetto—away from the environment that is undermining both their health and their education.

In part 2 of this post, I’ll describe that program—and the effect it could have on both health and education

Comments

[Alex Field]

Hi Maggie,

Great post. I wanted to let you know that we featured it on the RWJF Commission's home page at www.commissiononhealth.org. FYI, the Commission is set to release it's recommendations April 2, so I'll be in touch with details as that approaches.

Looking forward to part two!

Best, Alex

[Maggie Mahar]

Don--

Thank you very much for the kind words. I, too, am impressed by the people who comment here and am glad you have joined the discussion.

Yes,you can contribute to HealthBeat by contributing to The Century Foundation (TCF)--the non-profit organization that supports the blog.

Just let TCF know that you're contributing because you want to support HealthBeat.

Your contribution will be tax-deductible.

To contribute: Go to www.tcf.org,
scroll down and toward the end of the blue border on the left-hand side of the page, you'll see "donate to tcf" in small white type.

Click, and you'll find a form that lets you contribute and comment.

[Don Levit]

Maggie:
I would have written you personally, but I didn't notice another E-mail for my question.
I really enjoy this blog.
The people are extremely intelligent and passionate about health care reform. In addition, you take such an active part in writing the articles and commenting.
Is there any way we could contribute financially to the blog? It need not be tax deductible, although that would be great.
Don Levit

[Maggie Mahar]

Dr.Rick--

Thanks for your comment.

I've always liked Chris Dodd (I spent much of my adult life in Connecticut and he emerges as something of a hero in my first book, Bull!)

And Dodd is right: they are all connected.

[Dr, Rick Lippin]

Thanks Maggie-

Smart people know that education and healh are intimately linked.

During the DEM Presidential debates Sen Chris Dodd would often use the phrase "their all connected"

Those who choose to "silo" everthing are not dealing with reality.

Dr. Rick Lippin
Southampton,Pa