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May 06, 2009

On Education and Health

Given my general preoccupation over the last 90 days, I have not covered the RWJF Commission to Build A Healthier America as extensively as I would have liked, but I am pleased to note the release of the latest Commission report, entitled "Reaching America‚Äôs Health Potential:A State-by-State Look at Adult Health."

The overarching theme of the Commission stresses the difference between health and health care, a distinction well-studied in the general SDOH literature.  Even more intriguing the latest report notes the social gradient of health on the first page, even before the Executive Summary:

At every level of education and in every racial or ethnic group, Americans could be healthier. In almost every state, shortfalls in health are greatest among adults in the most disadvantaged groups, but even those typically considered middle class are less healthy than adults with greater advantages.

This is why it is so crucial to understand that the links between inequities and health go way beyond absolute poverty.  The connections adhere on the relative level as well, which means that it is not simply poor persons who suffer from increased morbidity and mortality (though in fact they do), but that even middle class persons are less healthy than slightly higher-class persons, who in turn are less healthy than those of slightly higher socioeconomic status, and so on and so forth in a kind of ladder.  This is the social gradient of health, and its significance is that profound inequities in a given community substantially undermine the health of persons at all socioeconomic levels.  In other words, it is not only the impoverished whose health is socially determined.

Perhaps the key finding in this latest report is a "consistent and striking pattern of incremental improvements in health with increasing levels of educational attainment: As levels of education rise, health improves."

This itself confirms a fairly substantial body of data in the SDOH literature linking education and health (However, it is important to note that the curve is fairly steep where there are widespread inequalities in education levels, but that it flattens significantly once education reaches a certain level).  This evidence coheres in important ways with the well-deserved focus on health literacy as a prime determinant of health, especially in the course of managing chronic illnesses (which is itself a social determinant of health, b/c how well one manages a chronic illness is obviously affected in profound ways by one's social and cultural contexts).

In any case, the RWJF Commission is doing important work, and merits reading for anyone interested in the SDOH.



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