11/04/2011 03:06 pm ET | Updated Jan 04, 2012

Improved Literacy Could Save Health Care

Despite incremental gains in health coverage among the ranks of previously uninsured Americans, some of the biggest concerns regarding the much-maligned Patient Protection and Affordable Care Act (A.C.A.) have come to fruition. Nearly two years since its signing into law, obesity and diabetes are still full-blown epidemics, private health insurers continue to gouge and thrive, and 44 percent of adult Americans go without insurance coverage every day. It's true that much of the meat of the legislation won't kick in until 2014, but critics claim that the finished product will still leave millions uninsured (and underinsured) while doing little to control costs.

One of the main problems with the A.C.A. -- for now and in the future -- is that it mainly addresses the code-red aspects of patient care, without placing enough emphasis on sustainable models of disease prevention. While examining the bigger picture has never been a strength of our nation's policy-making process, the current approach will continue to drive the U.S. health care system deeper into the pit of fiscal insolvency -- no doubt to the giddy delight of conservatives and their acolytes.

The good news is that there is a solution to the prevention conundrum, and it doesn't involve yet more screenings or an FDA ban on Cocoa Pebbles. It's one that will require patience and a willingness to give primacy to the ideas of experienced professionals over those of cloistered think-tankers. And if seen all the way through, it will also address yet another one of our nation's most intractable problems.

To rescue health care, we must first acknowledge and then reduce the literacy deficit incurred by low-income children.

We already know that wealthier kids overwhelmingly come from more stable households and attend schools with greater resources and more robust revenue streams. They are introduced to books as toddlers (or even earlier) grow up in environments in which literacy is valued and reading materials are plentiful, and come of age among peers who are likely to view attending college as a foregone conclusion.

We also know that a disproportionate number of poor kids struggle in the classroom. The evidence for this is irrefutable and the reasons many. Some live in chaotic households that throw their lives into constant flux; some are victims of abuse, neglect or malnutrition; and some have never had access to the pillars of cognitive development that so many of us take for granted as fundamental rites of childhood. (Many of my students, for instance, never watched Sesame Street or Blues Clues, were never read to by a family member and rarely discuss their school day with one or both or their parents.) The truly unfortunate kids must deal with a combination of these malignancies while somehow performing to the expectations of a 21st-century low-socioeconomic status (SES) school paradigm that requires them to focus on the rote memorization of factoids for seven hours a day. In speaking to this point, Eric Jensen, author of Teaching With Poverty in Mind, says, "Most low-SES kids' brains have adapted to survive their circumstances, not to get As in school."

Because of these unfortunate circumstances, poor kids lag behind their more affluent peers in virtually all areas of health and well-being. For instance, they're more prone to obesity, making them prime candidates for Type II diabetes. They're also more susceptible to a host of other chronic illnesses, drug and alcohol addiction, teenage pregnancy, depression, and physical disabilities. Stanford neuroscientist Robert Sapolsky writes, "...starting with the wealthiest stratum of society, every step downward in SES correlates with poorer health," adding, "the chronic stress induced by living in a poor, violent neighborhood, for example, could increase one's susceptibility to cardiovascular disease, depression and diabetes."

This gap in wellness between social classes also includes a considerable lag in neurocognitive functioning and development among economically disadvantaged children. What this means is that poorer kids have greater difficulties in processing and expressing language. Meanwhile, they also typically exhibit less impulse control and an alarming deficiency in their ability to recall and synthesize knowledge.

It shouldn't be shocking, then, to learn that kids from low-income families often go through grade school engaged in a tenuous relationship with books and that only one in seven meet grade-level expectations in reading.

As an English teacher at a Title I Los Angeles Unified School District (LAUSD) high school, I'm provided a front row seat for this slow-motion disaster each day. Despite the efforts of a number of dedicated colleagues and myself, I continually witness many of my students' relationship with the written word turn sour as they transition into secondary school. Frustration intensifies and interest wanes as vibrant illustrations gradually dissolve into even more advanced text -- along with concepts that require broader and yet more refined thinking skills. Hamstrung by compromised cognitive systems that were never given a chance to flourish, many kids eventually tire of the struggle. Reading becomes cumbersome, boring and seemingly pointless. Whereas avid young readers increasingly see books as an escape, these kids continue to slog through the joyless drudgery of word decoding.

For all of this, there are consequences. Says University of New Hampshire English professor Thomas Newkirk in Misreading Masculinity: Boys, Literacy and Popular Culture, "Unless you're reading fluently in late elementary school, getting an assignment to read a two-hundred-page book will just defeat you." Or, as one of my students recently put it: "How I feel about reading is like I am getting trapped and covered in words." It's no wonder why so many of these kids despise books.

During the first full week of school each year, I ask my incoming 9th-graders to reflect on their feelings about reading in a written composition. This is a fairly common practice among English teachers, but it never ceases to amaze me how eerily similar most of the responses are. This year, one student wrote:

My hatred for reading started when I was in kinder for a fact I hated everything about it one because I was force to read two because it is boring most of the books I have been forced to read for projects usually never caught my attention. Even though reading is good for me I hate it I cant stand it especially books like harry potter too many pages about a wizard kid I dont really care the movies are horrible. Also my family was not interested in reading either mostly because they dropped out of high school. To me books are nothing to me but it does teach you things but its a drag trying to read them.

Another student expressed virtually identical sentiments, writing:

I honestly think books are borring!! In this class you said your hoping to get us to like reading thats going to be a mission for you and me. I only read in class other than that I don't. I dont know why books just dont interest me. Ive only read 1 book that as a class we had to read. Honestly I dont have books in my house the only books I have are my 'textbooks' for school.

I chose these two responses partially to reveal the shoddy grammar, awkward sentence structure and underdeveloped vocabulary indicative of reluctant readers. But also note that both students talk about being "forced" to read "boring" material. As educated adults, we're often quick to dismiss such claims as hallmarks of adolescent lassitude, without considering that a good portion of what we perceive as apathy might actually be the ripple effects of deep frustration. It's true that much of the reading material foisted on public school students is insufferably boring. But the real problem is far more daunting. For a 15-year-old still struggling to sound out words on a page, even the greatest stories rapidly disintegrate into morale-crushing episodes of frustration.

Many of us forget that our own seminal explorations with the written word were infused with fun. We were the beneficiaries of a first rung of literacy replete with funky riddles, pop-up dinosaurs, clever critters and references to bodily functions. In contrast, for their first foray into the world of reading, many low-SES kids are being tasked with decoding Animal Farm or Lord of the Flies (or worse).

Proving that being poor is in itself a risk factor for academic peril, one study found the gap in reading proficiency between low-and-middle-income children to increase by three months during summer vacations. This is because poorer children often grow up in text-poor households where age-appropriate books and magazines are scarce. It's sad to think that these children are rarely encouraged to read at home and heartbreaking to know that many were never read to as young children.

Firing off another cautionary salvo, Kelly Gallagher, author of Readicide: How Schools Are Killing Reading and What You Can Do About It, notes, "If those students who enter schools linguistically impoverished -- thirty-two million words behind -- do not read extensively, they will never catch up." (Boys often get the worst of this calamity: many low-SES homes perpetuate a stigma against male eloquence, thus propagating an attitude among boys who, according to Newkirk, grow to view the act of reading as "girlie.")

Not surprisingly, these gaps in literacy lead to wholesale academic failure -- a pattern that repeats itself over generations. The conditions of poverty that beset families hinder literacy and academic growth; conversely, academic failure spawns more poverty -- and so on. Such a virulent feedback loop inevitably has a cascade effect on public health: Since poverty is both a predictor of academic struggles and of one's likelihood of contracting disease, individuals who fail to succeed in school are more likely to, at some point, cause a drain on the nation's already frayed health care system. What's more, the perpetual crisis mode triggered in the brains and bodies of poor children by ongoing stressors within their environment put them at greater risk for long-term physical and emotional illness.

Because the poor are less likely to have access to routine health care, unchecked ailments are more likely to metastasize into chronic diseases that tax emergency rooms, drive up insurance premiums and push families to the brink of financial ruin. Needless to say, this toxic scenario presents an enormous challenge not just for families trying to release themselves from the stranglehold of poverty, but for the future solvency of the American health care system.

Platitudes like "teacher quality is everything" oversimplify the complex web of challenges that confront both economically disadvantaged students and their teachers. They also lull the public into believing that poor kids are just a few pats on the back away from meeting the same challenges as their more affluent peers. This mindset grossly underestimates the amount of work that lay ahead in attempting to heal the systemic damage wrought by decades of social inequity. While it's true that every child can learn, poor children are at a distinct cognitive and emotional disadvantage. As such, they require a bevy of specific accommodations and strategies that will enable a reconfiguration of their cognitive processing systems to take place. For starters, this means abandoning the current high-stakes-testing-inspired drill-and-kill dogma that has neither made kids smarter nor more literate. Instead, a more holistic, interdisciplinary approach to learning is needed -- one that initiates critical thinking and infuses curricula with high-interest reading materials chosen to ignite kids' passion for books.

Or we can just carry on with the pretense that socioeconomic status, education, and health never cross paths -- the preferred approach by those with little or no skin in the game. The answers come much easier this way. But that doesn't necessarily make them right.