"I'm healthy! I went to college!"

Back in May, a report was released by the Robert Woods Johnson Foundation that ranked states according to the gap between college graduates and non-college graduates who rate themselves in “less than very good” health. Meaning, the states ranked the highest had the smallest gap in self-reported health status between those with college degrees and those without. Top-ranked states were Delaware, Hawaii, and Maryland. Lowest-ranked states were California, West Virginia, and Kentucky.

Click Here to download the report.

This report is chocked full of other data about self-reported health status among American adults, but I want to focus on the relationship found between education and health status. What they found was that as education levels rise, health improves.

As someone who’s been in the health field for years, I can look at these finding and say “Well, duh!” But is it all that intuitive? Let’s deconstruct it:

College Education > More Knowledge > Awareness of Health Risks > Healthy Behaviors > Reporting Good Health

OR

College Education > Higher Income > Ability to Regularly Access Health Care Services (by health insurance or out-of-pocket expenses) > Reporting Good Health

OR

Both?

I think the gap between college-educated and non-college-educated folks is somewhat a combination of the two models proposed above, but I think the main factor is probably linked to income. We know that people with higher education levels get paid more (check census data: http://www.census.gov/hhes/www/macro/032008/perinc/new03_000.htm)

I would venture to say that most Americans have access to basic health knowledge. Most children learn basic health behaviors all through primary school, from teeth-brushing to healthy eating. And there are so many public service announcements and news reports related to health nowadays (providing you have a television), so the basic knowledge is there. However, people who make more money are more able to access healthier foods (fresh veggies cost more!), physical activity (e.g. gym membership), and regular health care.

One thing that concerned me about the release of this report is that the chairman of the commission that put out this report said that in order to improve our nation’s health we need to improve education quality and education attainment. I’m all for improving the nation’s schools and giving every child the opportunity to go to college if they want, BUT…

-Do we really know that education actually precedes health status? I mean, which came first, the chicken or the egg? Maybe kids who already value health and consider themselves to be healthy, physically and mentally, go to college. Many college-bound kids are able to stay on their parents’ health insurance during their college years and maybe they see health insurance and regular health care as important. Who knows?

-Maybe before correcting the educational system in the US we need to fix the health care system. We ought to consider striving toward getting every person, regardless of age, equal access to health care. We’ve missed the boat on folks who will not go back for an education, so why not seek to meet their current needs? In the coming years, people over 80 will become the fastest growing age group in America and people over 50 will represent 35% of the population. Let’s meet the ever-increasing need for access to health care.

-Keeping in mind, access to health care and education alone will not fix the problem. Both issues need to be tackled to move toward improving the health status of the American people.

Don't Fix What Ain't Broke

One of the major political and public health issues facing our country today is Children’s Health Insurance. There has been a big push to cover all children in the US. It would be huge if we could figure out how to provide adequate and equal access to health services for all American children.

In recent years, there’s been some forward progress. But I learned recently that some states, such as North Carolina, are looking to take a big step backward by cutting school-based dental programs for children.

According to the CDC (www.cdc.gov) and ADA (www.ada.org), findings from several scientific studies show that school-based sealant programs work. These programs reach children at high risk for tooth decay, especially those who don’t have access to private dental care. Why would a state see an effective program as expendable?

Here’s why states should NOT cut school-based dental services:

1. According to the CDC, tooth decay (dental disease) is the most common health problem for school-aged children.

2. According to the state oral health survey in North Carolina, 1 in 4 children entering kindergarten show obvious signs of tooth decay. In many states, the percentage of 3rd graders with untreated tooth decay is upwards of 44%!

3. Recent studies conducted by researchers at Harvard and the University of Puerto Rico found a link between periodontal disease and obesity. These findings also have implications for links between oral health and heart disease and type 2 diabetes. Therefore, we ought to think of school-based dental services as preventive health services that extend beyond the teeth.

I’m not an economist, I’m a health educator. Do I understand that states have budget shortfalls? Yes. Do I understand why a state would cut a program that is effective and is good for the health of its future workforce? No. In my opinion, the economic returns of keeping a program of this nature far outweigh the costs…