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
Institute of Medicine 2001
National Research
Council 2001
National Institutes for Health
2000
Institute of Medicine
2000
Determinants of Health
Multiple levels of influence
Access to Health Care – 10%
Environment – 20%
Genetics – 20%
Healthy Behaviors – 50%
HEALTH
L
I
F
E
S
P
A
N
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
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, 1997-1999
T o ta l W A S ta te D e a th R a te s
A g e G ro u p a n d Ed u c a ti o n L e v e l
A ve ra g e A n n u a l D e a th R a te s, 19 97-199 9
52 5
55 -64
15 30
20 7
45 -54
627
99
35 -44
311
48
25 -34
172
0
500
S om e C olle ge
o r M ore
H ig h S c hoo l G radu ate
o r Le s s
100 0
150 0
R a te p er 10 0, 000
SOURCE: The Health of Washington State, 2002
2000
Table 1. National Graduation Rates, by Race or
Ethnicity and Sex, United States, 2001
Race or Ethnicity
Female %
Male %
Total %
American
Indian/Alaska Native
51.4a
47.0a
51.1
Asian/Pacific
Islander
80.0a
72.6a
76.8
Black
56.2
42.8
50.2
Hispanic
58.5
48.0
53.2
White
77.0
70.8
74.9
All Students
72.0
64.1
68.0
Source: Swanson CB A statistical portrait of public high school graduation, class of 2001. 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.).
Adequate public investment in education.
“Living wages” to move working families above poverty.
Access to quality health care for all ages.
Mixed income neighborhoods to decrease segregation by
SES.
Programs to reintegrate stigmatized populations.
Parenting classes in schools, churches, health agencies,
etc.
Neighborhood schools as site of numerous community
support programs.
Family-focused, one-stop health and human services
centers .
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
Influences Our
Health
What What
Influences
Our
Health
Healthy
Behaviors
51%
22%
Environment
Genetic
Makeup
17%
Health Care
10%
0%
20%
40%
60%
Source: McGinnis, et. al, 2002
80%
100%
We Spend
Money
How WeHow
Spend
Our
Money
Increase Healthy Behaviors
2.5%
Mitigate Environmental Hazards
2.5%
Identify & Mitigate Health Risk
0.3%
Factors
97.4%
Health Care
0%
20%
40%
60%
Source: Priorities of Government II, Summer 2004
80%
100%
“Investments in Education are Health
Investments
Investments in Health are Education
Investments”
Maxine Hayes
Academic
Achievement
Child &
Adolescent
Academic
Achievement
IMPACTS
IMPACTS
Adult Health
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.81124). Washington, D.C: National Academy Press. Available:
http://www.4.nas.edu/iom/iomhome.nsf.
• US Preventive Services Task Force. (AJPM April, 2003).
Sociocultural environment. In the guide to community preventive
services: Systematic reviews and evidence-based
recommendations. USDHHS. http://www.thecommunityguide.org