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

5 thoughts on “Health, Education and the Welfare of the Nation

  1. 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

  2. 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.

  3. 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

  4. 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 http://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.

  5. Hi Maggie,
    Great post. I wanted to let you know that we featured it on the RWJF Commission’s home page at http://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