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Investing in Health: Is Basic Education Better than Medicine?. Maxine Hayes, MD, MPH State Health Officer Washington State Department of Health December 11, 2007. We Know What Determines Health. Institute of Medicine 2001. National Research Council 2001. - PowerPoint PPT Presentation
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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