The inextricable link between health and education

Education leads to health. The link could not be clearer, based on a report from the Robert Wood Johnson Foundation (RWJF), Reaching America’s Health Potential: A State-by-State Look at Adult Health. This report follows up RWJF's look into children's health published in October 2008, Reaching America’s Health Potential Starts with Healthy Children: A State-By-State Look.

A key paragraph in the report sums up the fact that health status is impacted by other factors beyond health care:

"Being able to make healthy choices depends on physical and social conditions at home, in neighborhoods, at schools and at work. For example, a person’s ability—and motivation—to be physically active, eat a healthy diet and avoid smoking and excessive drinking can be diminished by living in a neighborhood that lacks safe places for physical activity, where there are liquor stores but no grocery stores, and where intensive tobacco and alcohol advertising is prevalent. But living and working in neighborhoods that have sidewalks and safe places to exercise, after-school recreation programs and
access to nutritious foods can promote good health by making it easier to adopt and maintain healthy behaviors."

Thus, education, income and one's racial or ethnic Group has direct bearing on one's health status.

In the period of 2005-7, 45% of all US adults between 25 and 74 said they were in less than very good health. This proportion varied from a low of 35% in Vermont (the self-reported 'healthiest state') to a high of 53% in Mississippi (the self-reported least-healthy state). That's more than one-half of Mississippi adults who believed they're none too healthy.

Across the US, the percent of adults in less than very good health varied by level of education. Least-educated adults were more than 3 times as likely in some states to be in less than very good health compared to college graduates. Health improves with the level of education: high school graduates were more likely than college grads to be in less than very good health.

Health status among adults also varied across racial and ethnic groups. The percent of adults in less than very good health tends to be lower among non-Hispanic whites than in all other groups. Non-Hispanic black and Hispanic adults typically were most likely to be in less than very good health—more than twice as likely as white adults, in some states, RWJF found.

A point in the methodology should be noted: adult respondents could self-report their health status as "excellent," "very good," "good," "fair" or "poor." RWJF segmented "excellent and very good" health from lower health status categories as an "optimal health" measure versus lower levels of wellness.

Health Populi's Hot Points: Healthy lifestyle choices have a direct determining influence on personal health. National health reform can impact access to health care services, but that's only one-half of the determinants of health. There will remain health disparities and un-wellness among people with lack of access to healthy environments, workplaces, and neighborhoods.

Furthermore, RWJF data reveals that even among middle-income adults, there is a fairly high level of people with diminished quality of life and increased disability that could be prevented by healthier choices. Here, some "libertarian paternalism," the kind of which I wrote about in yesterday's blog that recommended "nudging," could go a long way to motivating people to make sound choices that bolster health status.

For more on working with people to maximize health status "where they live," see RWJF's report, Collaborating Where Health Happens.