The most important impacts on our health come from the “social determinants of health,” those social and environmental factors in which people live, work, play, and pray. These account for more than 50 percent of what makes you healthy (Hood, Swain, et al; Am J Prev Med 2016;50(2):129–135).
That means that socioeconomic factors like education, employment, income, transit, child care, and housing are more important to your health than just having a good doctor. And, of those factors, education is one of the most important.
To put it simply: Knowledge is power, in more ways than one. www.rwjf.org/content/dam/web-assets/2009/09/education-matters-for-health
Education drives health in multiple ways. Higher educational attainment leads to higher levels of health knowledge and health literacy, leading to an increased likelihood that you will engage in healthy behaviors.
Educational attainment also strongly determines your occupational choices. Your job, in turn, determines working conditions that affect your health, work-related resources (health insurance, sick leave, and retirement benefits), and, most importantly, income level – which determines whether you can afford to live in a healthy house and neighborhood, feed your family healthy food, and more.
But a third connection between education and health may be the most powerful of all: through chronic stress.
Stress releases certain hormones in the body such as cortisol and adrenaline. Everyone has episodic stress – the stress that comes from a bad day at work or a difficult interaction with another person. When you have resources available and a safe house or neighborhood to go home to, your stress levels (and stress hormones) decrease after the stressful event passes.
But chronic stress – for example, the underlying stress that comes from living conditions connected to having low educational attainment – means your stress hormone levels stay high all the time. Your body doesn’t get a break. This adversely impacts how your body functions.
Chronically elevated stress hormones directly cause high blood pressure (which leads to heart disease and stroke), they impair glucose metabolism (which leads to obesity and diabetes), and they impair immune system functioning (increasing risk for cancer and other chronic diseases).
For girls and young women, elevated stress hormones also impair reproductive health during pregnancy, worsening blood flow to the placenta and leading to babies being born too small, and making the muscle in the uterus more irritable, greatly increasing the risk of premature labor.
The effect of this on educational opportunity is powerful. As an example, even very slightly preterm babies have, on average, statistically significant worse 3rd grade reading scores than babies born even one week closer to full term (Noble et al, PEDIATRICS, Volume 130, Number 2, August 2012, p. e257-e264).
So, low educational attainment increases the chance of being in poor health. But poor health also increases the chances of low educational attainment. Kids who miss school because of illness miss learning opportunities. And children who have chronic illnesses like asthma, have been exposed to hazards like lead, or who have chronically elevated stress levels from their living conditions, are going to have a harder time learning.
My point is this: Good health and good education go hand-in-hand. Educators know that you have to be healthy to get a good education. Public health professionals know that a good education makes you much more likely to be healthy. Our success in one field depends entirely on our success in the other.
So, what do we do? Step one: educators and public health professionals must get to know each other better.
We must look at the intersections of work such as Milwaukee Succeeds, with the work of initiatives like the Lifecourse Initiative for Healthy Families. We must support each other’s initiatives, both in policy and in practice. Examples include trauma-informed care, assuring quality in child care settings, advocating for universal pre-K, and supporting clinic-based educational program such as Reach Out and Read. Many more resources are available at www.raisingofamerica.org.
And so I will close with a New Year’s wish: Here’s to achieving our mutual goals through closer and more effective working relationships between educators and health professionals!
Happy New Year,
Dr. Geoffrey Swain