Investing in Health:Investing in Health:Is Basic Education Better than Is Basic Education Better than

Medicine?Medicine?

Maxine Hayes, MD, MPHMaxine Hayes, MD, MPHState Health OfficerState Health Officer

Washington State Department of HealthWashington State Department of HealthDecember 11, 2007December 11, 2007

We Know What Determines We Know What Determines HealthHealth

National Institutes for Health 2000

Institute of Medicine 2001

National Research Council 2001

Institute of Medicine 2000

Determinants of HealthDeterminants of Health

LIFE

SPAN

Multiple levels of influence HEALTHHEALTH

Access to Health Care – 10%Access to Health Care – 10%

Environment – 20%Environment – 20%

Genetics – 20%Genetics – 20%

Healthy Behaviors – 50%Healthy Behaviors – 50%

Medical Care is Medical Care is NOTNOT the the Primary Determinant of Health!Primary Determinant of Health!

What are Social Determinant of What are Social Determinant of Health?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 Education is a Strong Social Determinant of HealthDeterminant of Health

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

THE NEW YORK TIMESTHE NEW YORK TIMES

THE NEW YORK TIMESTHE NEW YORK TIMES

A Surprising Secret to a Long Life: Stay in A Surprising Secret to a Long Life: Stay in SchoolSchool

By Gina KolataBy Gina Kolata

January 3, 2007January 3, 2007

Total WA State Death Rates Age Group and Education Level

Average Annual Death Rates, 1997-1999

172

311

627

1530

48

99

207

525

0 500 1000 1500 2000

25-34

35-44

45-54

55-64

Rate per 100,000

Some College or More

High School Graduateor Less

Death Rates by Age and Educational LevelWashington State, 1997-1999

SOURCE: The Health of Washington State, 2002

Table 1. National Graduation Rates, by Race or Table 1. National Graduation Rates, by Race or Ethnicity and Sex, United States, 2001Ethnicity and Sex, United States, 2001

Race or EthnicityRace or Ethnicity Female %Female % Male %Male % Total %Total %

American American Indian/Alaska NativeIndian/Alaska Native

51.4a51.4a 47.0a47.0a 51.151.1

Asian/Pacific Asian/Pacific IslanderIslander

80.0a80.0a 72.6a72.6a 76.876.8

BlackBlack 56.256.2 42.842.8 50.250.2

HispanicHispanic 58.558.5 48.048.0 53.253.2

WhiteWhite 77.077.0 70.870.8 74.974.9

All StudentsAll Students 72.072.0 64.164.1 68.068.0

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 Academic Achievement is Central to Achieving the Goal of to Achieving the Goal of

Eliminating Health DisparitiesEliminating Health Disparities

PREVENTING CHRONIC DISEASEPREVENTING CHRONIC DISEASEPUBLIC HEALTH RESEARCH, PRACTICE, AND POLICYPUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY

SPECIAL TOPICSPECIAL TOPIC

Reframing School Dropout as a Public Reframing School Dropout as a Public Health IssueHealth Issue

Nicolas Freudenberg, DrPH, Jessica RuglisNicolas Freudenberg, DrPH, Jessica Ruglis

CDCCDC

Volume 4: No. 4, October 2007Volume 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 HealthRanked by Potential to Improve Community Health• Child development programs (Head Start, Healthy Start, Child development programs (Head Start, Healthy Start,

etc.).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 Mixed income neighborhoods to decrease segregation by

SES.SES.• Programs to reintegrate stigmatized populations.Programs to reintegrate stigmatized populations.• Parenting classes in schools, churches, health agencies, Parenting classes in schools, churches, health agencies,

etc.etc.• Neighborhood schools as site of numerous community Neighborhood schools as site of numerous community

support programs.support programs.• Family-focused, one-stop health and human services Family-focused, one-stop health and human services

centers .centers .• Adequate health benefits with employment.Adequate health benefits with employment.The Guide to Community Preventive Services. The Guide to Community Preventive Services. “Interventions in the Social Environment to Improve Community Health: “Interventions in the Social Environment to Improve Community Health: A Systematic Review”A Systematic Review” AJPM April 2003AJPM April 2003

What Influences Our HealthWhat Influences Our Health

10%

17%

22%

51%

0% 20% 40% 60% 80% 100%

Health Care

GeneticMakeup

Environment

HealthyBehaviors

Source: McGinnis, et. al, 2002

How We Spend Money

0.3%

2.5%

2.5%

97.4%

0% 20% 40% 60% 80% 100%

Health Care

Identify & Mitigate Health RiskFactors

Mitigate Environmental Hazards

Increase Healthy Behaviors

Source: Priorities of Government II, Summer 2004

How We Spend Our MoneyHow We Spend Our Money

““Investments in Education are Health Investments in Education are Health InvestmentsInvestments

Investments in Health are Education Investments in Health are Education Investments”Investments”

Maxine HayesMaxine Hayes

Academic

AchievementIMPACTS Adult Health

Child & Adolescent Academic

Achievement

IMPACTSChild &

Adolescent Health

Status or Behaviors

““You can’t educate a child who is not You can’t educate a child who is not healthy and you can’t keep a child healthy and you can’t keep a child

healthy who is not educated”healthy who is not educated”

Joycelyn Elders

ReferencesReferences• 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.81-124). 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