A single fruit symbolizes the nexus of two of our country's most important industries. Though the saying goes, "an apple a day keeps the doctor away," America's children are more than happy to plop a Granny Smith on a teacher's desk as a token of gratitude. How easily could we remedy the ills of our nation's health care and education systems if we could just get those kids to keep -- and eat -- those delicious fruits? (As a former teacher, I prefer clementines anyways.)
Yet the interdependence of American health care and education goes beyond the exchange of a few figurative red deliciouses. In particular, as we watch our ongoing national debt drama, it is essential to remember that the slice of the budgetary pie most hazardous to our long term economic health is exactly that slice most at the mercy of our propensity to eat pie. The cost of our health care, unsurprisingly, is growing along with our waist lines. But everyone knows that. What they don't know is that in addition to the overabundance of food fattening our kids' bodies, our children also are also suffering from a famine of food for thought, a failing school system that is directly contributing to both their poor health care outcomes and their high health care costs.
I sat down with Jay Feldstein, D.O., regional president, Northern Division for Amerihealth Mercy Family of Companies, an organization that provides managed care plans for Medicaid patients, to pick his brain on this issue, and to discuss the ways that the players in our health care system -- and insurance companies in particular -- could partner with our education system in order to improve their members' lives.
Me: How significant is the link between educational attainment and health outcomes?
Dr. Feldstein: It's substantial. Compared with college graduates, individuals who have not completed high school are four times more likely to report being in fair or poor health. And if we analyze life expectancy from age 25, college graduates will live five to seven years longer than their peers who did not earn a high school diploma. Furthermore, these problems arise even before a person has had the opportunity to begin his or her own education. The children of high school dropouts are six times more likely to be in fair or poor health than those of college graduates, and babies born to mothers who haven't finished high school are twice as likely to die in their first year of life. This is an issue that affects all Americans regardless of gender, race or ethnicity, and it is imperative that we address it as a matter of both economic necessity and social justice.
Me: What causes these dramatic differences in overall health?
Dr. Feldstein: Numerous factors contribute to these disparities. I would break it down into three buckets. The first is the fact that health literacy is a branch of overall literacy. Less literate individuals are less likely to be aware of healthy behaviors and are thus less likely able to partner with their health care providers in order to ensure that they are leading healthy lives. The second reason is that people with less education tend to end up in careers with poorer working conditions, lower pay and worse, if any, health benefits. And last but not least, the feelings of powerlessness, the diminished self-efficacy and the lack of support networks associated with having less education all play a role in a person's ability to manage their own health.
Me: What does this mean for our health care system?
Dr. Feldstein: The imperative to improve our schools has mostly been driven by the necessity of enhancing the competitiveness of our workforce and by a desire to do the best by our kids. It has not been narrated from the perspective of education's importance to our nation's overall health. Insurance companies especially should evaluate opportunities to involve themselves in the schooling of their covered lives, as the health care costs associated with poor education are alarming. This is particularly important for Medicaid, as a quarter of all Medicaid beneficiaries are high school dropouts.
Me: What steps do you think insurance companies should consider taking?
Dr. Feldstein: At AmeriHealth Mercy we are currently considering offering people who are covered by our health plans but who do not have high school degrees support to pursue their GEDs. But that's just a start. I can imagine a world in which insurance companies partner with their local school districts to provide coordinated health education to students. In my opinion, the most important teacher in a school is the gym or health teacher, but that is a devalued role in our education system today. We should work to elevate the status of health and wellness education in our schools by providing those educators with the tools that they need in order to give their students the skills to live healthy, productive lives.
Me: Is this just about controlling costs?
Dr. Feldstein: No. This is a social justice issue. The research shows that lives are at stake here, and we cannot stand idly by and watch as people suffer, not just economically, but physically, because they don't get a good education.
To summarize, the failings of our education system not only threaten our nation's financial future, but also the future of our human dignity. The facts are disturbing. It's one thing when one's educational attainment affects one's economic opportunities. It's something else entirely when a person can expect to lead a shorter, unhealthier life because of a poor education.
The lesson here is a simple one: if we want to prescribe the best preventive medicine for America's health care system it would be to provide all American children with the high quality education that they deserve. And we could always give every kid an apple a day, so long as we ensure that they eat them themselves.
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