Investing in Health: Is Basic Education Better than Medicine? Maxine Hayes, MD, MPH State Health Officer Washington State Department of Health December 11, 2007

We Know What Determines Health National Institutes for Health 2000 Institute of Medicine 2001 National Research Council 2001 Institute of Medicine 2000

Determinants of Health LIFESPANLIFESPAN Multiple levels of influence HEALTH Access to Health Care – 10% Environment – 20% Genetics – 20% Healthy Behaviors – 50%

Medical Care is NOT the Primary Determinant of Health!

What are Social Determinant of Health? Social determinants of health refer to societal conditions that affect health and that potentially can be altered by informed action. Job opportunities Opportunities for education Social norms – e.g., dropping out of school Housing conditions and exposure to environmental hazards Availability of services and access to resources

Education is a Strong Social Determinant of Health

“The one social factor that researchers agree is consistently linked to longer lives in every country where it has been studied is education. It is more important than race; it obliterates any effects of income.” THE NEW YORK TIMES

A Surprising Secret to a Long Life: Stay in School By Gina Kolata January 3, 2007

Death Rates by Age and Educational Level Washington State, SOURCE: The Health of Washington State, 2002

Table 1. National Graduation Rates, by Race or Ethnicity and Sex, United States, 2001 Race or Ethnicity Female % Male % Total % American Indian/Alaska Native 51.4a47.0a51.1 Asian/Pacific Islander 80.0a72.6a76.8 Black Hispanic White All Students Source: Swanson CB A statistical portrait of public high school graduation, class of Washington DC: The Urban Institute; 2004 a Rate based on estimates that cover between 50% and 75% of the student population.

Academic Achievement is Central to Achieving the Goal of Eliminating Health Disparities

PREVENTING CHRONIC DISEASE PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY SPECIAL TOPIC Reframing School Dropout as a Public Health Issue Nicolas Freudenberg, DrPH, Jessica Ruglis CDC Volume 4: No. 4, October 2007

SOCIAL DETERMINANTS OF HEALTH: INFORMING POLICY DECISIONS Social conditions that affect health are amenable to population-based interventions that improve community health outcomes.

Ranked by Potential to Improve Community Health Child development programs (Head Start, Healthy Start, etc.). Child development programs (Head Start, Healthy Start, etc.). Adequate public investment in education. Adequate public investment in education. “Living wages” to move working families above poverty. “Living wages” to move working families above poverty. Access to quality health care for all ages. Access to quality health care for all ages. Mixed income neighborhoods to decrease segregation by SES. Mixed income neighborhoods to decrease segregation by SES. Programs to reintegrate stigmatized populations. Programs to reintegrate stigmatized populations. Parenting classes in schools, churches, health agencies, etc. Parenting classes in schools, churches, health agencies, etc. Neighborhood schools as site of numerous community support programs. Neighborhood schools as site of numerous community support programs. Family-focused, one-stop health and human services centers. Family-focused, one-stop health and human services centers. Adequate health benefits with employment. Adequate health benefits with employment. The Guide to Community Preventive Services. “Interventions in the Social Environment to Improve Community Health: A Systematic Review” AJPM April 2003

What Influences Our Health 10% 17% 22% 51% 0%20%40%60%80%100% Health Care Genetic Makeup Environment Healthy Behaviors Source: McGinnis, et. al, 2002

How We Spend Our Money

“Investments in Education are Health Investments Investments in Health are Education Investments” Maxine Hayes

Academic Achievement IMPACTSAdult Health Child & Adolescent Academic Achievement IMPACTS Child & Adolescent Health Status or Behaviors

“You can’t educate a child who is not healthy and you can’t keep a child healthy who is not educated” Joycelyn Elders

References Evans, R.G., Barer, M.L., & Marmor, T.R. (Eds.). (1994). Why are some people healthy and others not? The determinants of health of populations. New York: Adline de Bruyter; US Department of Health and Human Services. (200). House, J.S., & Williams, D.R. (2000). Understanding and reducing socioeconomic and racial/ethnic disparities in health (Paper contribution B to the Institute of Medicine Committee on Capitalizing on Social Science and Behavioral Research to Improve the Public’s Health). In B.D. Smedley & S.L. (Eds.), Promoting Health: Intervention strategies from social and behavioral research (pp ). Washington, D.C: National Academy Press. Available: US Preventive Services Task Force. (AJPM April, 2003). Sociocultural environment. In the guide to community preventive services: Systematic reviews and evidence-based recommendations. USDHHS.