Junior, do your homework so you can grow up to be big and strong.

There is an undeniable link between education and health, even as we age. More school translates to:

- Lower incidence of virtually every chronic disease;
- Longer life span; and
- Higher self-ratings of health at every age (1).

But why and how education makes us healthy is not as clear. Some advantages of book work are obvious: education allows you to get a better job, earn more, have access to health care benefits, and perhaps gain a better grasp of health information that allow you to make better decisions. All true, but none fully explain the positive effect that education has on health. It is more complex than these factors alone (1, p. 51).

It’s not just the amount of education, either. A recent study found that students with the same years of schooling but higher performance had better health outcomes later in life than those who performed poorly. Something about the actual process of learning and performing matters(2).

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This post is the first in a new six-part series of posts from Wendy Lynch. In coming months, Ms. Lynch will be exploring other issues related to the health care and health as human capital.

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Just as startling are data from the “Nun study” which has shown that the quality of one’s thinking and writing early in adult life correlates with cognitive ability and health 60 years later (3, 4). Other things being equal, nuns whose writing in the 1930s showed higher “idea density” were better off physically and cognitively when they reached their 90s and lived an average of seven years longer than nuns whose writing was not as advanced.

Is dropping out the biggest health risk?

Studies like these can’t help but broaden our notion of “health” policy. The more I understand about learning and health, the more I cringe when I compare the almost 18 percent of GDP we spend, often inefficiently, on health care to the less than 6 percent we spend on education (5,6). If the amount and quality of learning we experience early in life has significant health implications, should we not be debating a more holistic approach to health care and prevention? What if dropping out before graduating from high school is a bigger health risk than smoking? What if standardized education rather than problem-based learning is similar to toxic environmental exposures when it comes to future brain health?

These connections between learning and well-being should magnify our concern about recent trends: U.S. students now rank 24th among developing countries in math skills (7). Over the past 20 years, American children have had a significant drop in measured creativity after 30 years of steady improvement (8).

Why isn’t this connection made more often?

It’s common, especially in politics, to oversimplify complex topics. When answers are hard to find and media stories follow a 60-second-sound-bite format, complexity is inconvenient; social complexity even more so. We want concrete, straightforward solutions that actually work, but these are rare. By itself, raising minimum wage does not eliminate poverty. Providing more books does not erase illiteracy. And more medicine … well, you get the picture.

As a new crop of policymakers prepares to re-debate rules about health care and expenditures, notice how often they equate fighting for health care or health insurance with fighting for health and well-being. That’s because insurance and medicine are easy to define, even when the links to health improvement are not.

Medicine and health are not the same.

Solutions would be so much easier if more medicine always produced better health. We are a culture that loves its biomedical miracles—a pill for each ailment, a procedure for each flaw. Science has connected the dots for us: genes and cells misbehave, so manipulations of biochemistry will correct the error. The last 60 years have brought millions of discoveries to reinforce medical cause and effect, man-made healing in packages of creams and capsules, replacement parts made of titanium and Teflon. If everything can be fixed, we argue, it makes sense to continue investing in the tools and skills required for fixing.

As 2011 shapes up to be yet another round in the endless fight about health care, now is a good time to remind ourselves of the big, complex picture. Let’s revisit some the inconvenient facts:

1. America spends more on health care than any developed country, but falls far behind other nations in its “health” metrics. If health is our objective, we don’t get our money’s worth. We spend almost $7,300 per person, yet rate at the very bottom among seven advanced nations on the longevity of our citizens and quality and efficiency of care delivery (9).

2. After a certain point, more health care does not make us healthier. Of course, there are aspects of medicine that are both necessary and beneficial, but there is a point of diminishing returns where the marginal value is questionable. Estimates vary, but we may be spending as much as 30 percent more than we need to (10).

3. Health care is not the primary determinant of a population’s health. The evidence against health care in isolation is powerful, leading experts to suggest that “… health policy must move beyond a single-minded focus on the delivery and financing of health care” (1, p. 5).

So, why do we fight so hard for MORE care, MORE spending, and MORE access? Even that is a complex issue. Partly , the political fight represents the influence of a very powerful medical industry which invests hugely in lobbying and campaign support. Partly, it represents our underlying human fear of mortality. We worry that when the time comes, we might be denied a life-saving procedure for ourselves or our loved ones. And partly, we fight for health care because it is a convenient, simple proxy for what we really want—to be well. Someone else fixing us is much more desirable than what it might take to fix ourselves.

Even if it’s not getting us better health, what’s wrong with being the country that gets the most medical care?

Well, besides the harmful direct effects of unnecessary care, the biggest problem with overspending on health care is what we could be doing with extra $3,500 per person we spend compared to most other countries. There is a sad irony when health care leaves us so little to invest in education, which is far more preventive and likely to bolster population health in the first place. One can’t help but think about the vast difference in value our society places on doctors versus teachers.

Arguably, throwing more money indiscriminately at our education system is no wiser than throwing money at health care. However, one could argue that the broad return on smart educational investments is greater than many of the services covered by health insurance today. Perhaps a large dose of analytics and problem-solving in fifth grade would translate into fewer cases of chronic illness as those students reach middle age. Junior, do your homework so you can grow up to be happy and healthy.

As 2011 brings us more debates about mandatory medical insurance and allowable medical procedures, let’s remind ourselves that we are arguing over access to treatments for many conditions we can and should prevent. More importantly, prevention may come in forms we categorize as non health-related, such as education, housing, and nutritious food.

Better education means better job opportunities and lifetime earnings, but it also means better health. But first we have to be smart enough to allocate social investments in the right places. It’s time for us to think differently about what matters most.

And if all this thinking gives you a headache, take two math problems and call me in the morning.

References

1. Schoeni RF, House JS, Kaplan GA, Pollack H. Making Americans Healthier: Social and Economic Policy As Health Policy. New York: Russell Sage Foundation Publications; 2010.

2. Herd P. Education and health in late-life among high school graduates: Cognitive versus psychological aspects of human capital.  J Health Soc Behav. 2010;51:478-96.21131622.

3. Snowdon D, Geiner L, Kemper S, Nanayakkara N, Mortimer J. Linguistic ability in early life and longevity: Findings from the nun study. In: Robine J-M, ed. The Paradoxes of Longevity. Berlin; New York: Springer; 1999:103-113.

4. Snowdon DA, Kemper SJ, Mortimer JA, Greiner LH, Wekstein DR, Markesbery WR. Linguistic ability in early life and cognitive function and Alzheimer’s disease in late life. Findings from the Nun Study.  JAMA 1996;275:528-32.8606473.

5. Centers for Medicare & Medicaid Services, US Department of Health & Human Services. National health expenditure data fact sheet. Nov 23, 2010. Available at: https://www.cms.gov/NationalHealthExpendData/25_NHE_Fact_Sheet.asp. Accessed January 2, 2011.

6. NationMaster.com. Education spending (% of GDP) (most recent) by country. Available at: http://www.nationmaster.com/graph/edu_edu_spe-education-spending-of-gdp. Accessed January 2, 2011.

7. Chivvis D. Why are Chinese students walloping US kids on test? December 7, 2010.  Available at: http://www.aolnews.com/2010/12/07/why-are-chinese-students-walloping-us-kids-on-test/.  Accessed January 2, 2011.

8. Bronson P, Merryman A. The creativity crisis. July 10, 2010. Available at: http://www.newsweek.com/2010/07/10/the-creativity-crisis.html. Accessed January 2, 2011.

9. Davis K, Schoen C, Stremikis K. Mirror. Mirror on the wall. How the performance of the U.S. health care system compares internationally. June 2010.  Available at: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2010/Jun/1400_Davis_Mirror_Mirror_on_the_wall_2010.pdf.   Accessed January 2, 2011.

10. Kolata G. Law may do little to curb unnecessary care.  New York Times. March 29, 2010.  Available at: http://www.nytimes.com/2010/03/30/health/30use.html. Accessed January 2, 2011.

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