Santorum, Snobbery & Schoolin'

I was recently lamenting to my friends that sometimes I wish this were a blog about politics so that I could rant and rave about the lunacy being spewed by the current presidential candidates. Then I decided that I could find a health-related theme for the subject about which I would like to rant as an excuse to do it anyway. So here goes my rant about Santorum's infamous recent comments about higher education.

Let me start by saying that I am registered as a political independent. I have voted for members of both parties, and it is rare that I agree with either party 100% on an issue. But on this particular issue, I don't see much room to argue with Obama. I know full well that education makes a difference, not only in lifetime earning potential, but also in human health!

For those who haven't heard yet, Rick Santorum called Obama a "snob" for reportedly "saying that everyone should go to college." This was hard for me to believe, but here is an actual video of the speech in Michigan.

Of course, after hearing such a strange insult to our president, I decided to find out what Obama actually said. According to a Politico article, the quote was, "I ask every American to commit to one year or more of higher education or career training. This can be community college or a four-year school, vocational training or an apprenticeship. But whatever that training will be, every American will need more than a high school diploma."

It's hard for me to see how this quote translates into liberal snobbery mandating that everyone must attain a degree. That is clearly a limited and disingenuous reading of what was said. Obama was discussing the fact that increasingly, we are competing globally with countries who are focusing on education. Years down the road, it may become more and more difficult to find a job with only a high school diploma. This is not to say that people who do not go to college are somehow less important, not hard working, or otherwise bad. It is simply to state the fact that job prospects are better for those who attend some form of higher education, and this is becoming more true with each generation.

Consider the current economic issues in our country. According to the Bureau of Labor Statistics, the average unemployment rate in 2010 was 8.2%. However, among those with a bachelor's degree (and no master's) it was 5.4% compared to 10.3% for those with only a high school diploma.

One article I read in the San Francisco Chronicle said that the median annual pay of those 25 years and older with a bachelor's degree is $56,472. That is 70% higher than those without a diploma. That means a person with a college degree may individually earn about the same as the average household income (presumably a measure of the total earnings of multiple persons living together) in our country. According to the same article, 30% percent of adults now hold college degrees, and 94% of parents with children under age 18 expect their children to go to college.

Now to be fair, I do think there are people who are prejudiced against those of a different social class or education level. It's great to speak out against that sort of intolerance. And I agree with Santorum that there are plenty of hard-working people at important jobs without one minute of higher education. I think many Americans, especially in small towns across the nation or in manufacturing centers like Detroit, would echo sentiments of pride in their communities, regardless of the average education levels in the areas. It is even true that some people have gone on to make millions without a degree (Bill Gates, for example - and for him, it was billions). As the Montgomery Gentry song, "Where I Come From," says, "That old man right there in the rocking chair at the courthouse square - I'll tell you now he could buy your fancy car with hundred dollar bills. Don't let those faded overalls fool ya'. He made his millions without one day of schoolin." Pride in your job and loyalty to your friends and family of all social classes are beautiful things. I agree wholeheartedly that education does not make one person better than another. The idea that our worth as a person is not determined by our social status, income, or level of education resonates strongly with my understanding of humanity. Amen to equality before God!

But the fact remains that statistics show average quality of life increases with higher education. No, that does not mean for every person every time. It means for most people most of the time. And I do not in my heart believe that Obama is among the ranks of the socioeconomically prejudiced for acknowledging this. I find it especially improbable that there is much truth behind the accusations of elitism given that Obama's life before running for Congress involved working with residents in the south side of Chicago.

Santorum also berated higher education for "indoctrinating" young people into liberalism. I would agree that there is a left bent in higher education as a whole, but there are a few things to point out here. (1) Not every professor holds the same views. (2) If conservatives do not obtain higher ed degrees, then they cannot become professors. So it stands to reason that if Santorum sees a problem of disproportionate representation among college faculty, he should be encouraging more conservatives to get degrees, not fewer. Hey, if there were enough of them banded together, they could even start new colleges. (3) As my husband intelligently pointed out to me the other day, colleges not only produce liberal thinkers, they also produce deeper conservative thinkers who are able to counter balance the arguments of liberalism. Without a strong understanding of politics, philosophy, economics, and the like, it is pretty difficult to make a believable case against an expert in one of those fields. Please do not mistake me for saying that education is the sole predictor of good ideas. That is certainly not true. But how does Santorum intend to fight "elite leftist" ideas if he has not also read the same texts, analyzed the same arguments, etc.? How can a person condemn a book he or she has never seen? How can an individual make a point against a philosophy he or she has never heard? We need more thoughtful thinkers of all political persuasions, not fewer.

So you may be wondering what this has to do with "mind and body musings?" Well, I found something that clearly justifies this entire rant! Education is also a predictor of....drum roll....health! According to the National Poverty Center, better educated people have lower morbidity for many chronic illnesses and higher overall life expectancy. The NPC also states, "Health behaviors alone cannot account for health status differences between those who are less educated and those who have more years of education."  The policy brief I read suggested that some likely contributing factors to the health gap are complicated relationships between education and family background, effects of poor health in childhood, greater resources associated with more education, a learned appreciation for positive health behaviors, and social networks, among other mechanisms.

As I discussed in a previous blog post, education is also related to health literacy. To reiterate some of the statistics from that piece, the National Assessment of Adult Literacy targeted a portion of its latest assessment using health care related questions. The study found that among adults who never completed high school, approximately 49% had below basic health literacy, compared to 15% of adults who completed a high school diploma with no post-secondary education and just 3% of adults with a bachelor's degree. Low health literacy can inhibit someone's ability to read health pamphlets, follow medication instructions, make medical decisions when caring for a loved one,  understand post-operative instructions, or complete other similar tasks.

In another related post, I described some of the connections between food insecurity and obesity. Since food insecurity is a socioeconomic issue, and lack of education is a predictor of lower earnings, these problems are a likely link between education and health. Some of the issues I discussed in more detail in that post include fewer full service grocery stores in lower income neighborhoods, lower quality produce, a greater prevalence of fast food, fewer parks or recreation centers, and less access to health care, among other concerns.

I believe that Santorum was misguided in his Obama name-calling on the higher education topic. He was speaking to a crowd in Detroit, and it seems likely to me that he was catering to his audience. I'm not even going to get into Santorum's campaign goals from past years related to higher education (but please do Google the topic - he used to think college was a good idea). Suffice it to say that a quick glance at Santorum's own life and credentials makes it clear that his education got him where he is today and that he intends to provide the same for his children (just like 94% of parents hope for their own kids, as mentioned above).

As LZ Granderson of CNN put it, "Granted, some of us are gullible enough to give each other high-fives because Rick Santorum called Obama a snob for promoting a college education. But the rest of us look at 'Slick Rick's' college degree, law degree and MBA, and the fact that he's sending his kids to college and owns at least six properties, and has earned millions, and wonder - What is he talking about?"

I have been wondering that myself.

Health Literacy...Say What?

One issue in health care that is rarely discussed in the public domain, but which deserves significant attention, is health literacy. Health literacy is not the same as the general ability to read and write, although it is often related. Health literacy specifically refers to an individual’s capacity to “obtain, process, and understand basic health information and services needed to make appropriate health decisions.” (Institute of Medicine 2004)

Health literacy comes into play whenever a person purchases or administers a medication, reads an article about a health topic, fills out an insurance form, or discusses treatment with a doctor. It can impact the way parents care for a sick child or how adult children manage the health care of an ailing parent. It influences how an individual selects insurance coverage or how a person without insurance makes health decisions. In fact, health literacy contributes to almost every aspect of a person’s interactions with their own health, the health of those around them, and the healthcare system.

In 2003, the National Center for Education Statistics (NCES) conducted the National Assessment of Adult Literacy (NAAL). In additional to measuring general population literacy, they included a health-specific section of tasks to test individuals’ abilities to understand health texts (such as pamphlets), to utilize health forms in various formats, and to complete basic health care computations. These areas of ability were used to create a health literacy scale with four levels of performance: Below Basic, Basic, Intermediate, or Proficient.

The results of the testing showed that 12% of adults were proficient, 53% were at the intermediate level, 22% had basic skills, and 14% had below basic health literacy.

The results varied by several demographics. For example, women had higher average health literacy than men. White and Asian/Pacific Islander adults had higher average health literacy than adults of other racial/ethnic groups. Hispanic adults had lower average health literacy than adults in any other racial/ethnic group. Adults over age 65 had lower health literacy, on average, than younger adults. Literacy level also varied based on socioeconomic status, native language, media/internet access, and insurance status.

In addition, the NAAL showed that health literacy varied widely with education level. Among adults who never completed high school, approximately 49% had below basic health literacy. By contrast, 15% of adults who ended their formal education with a high school diploma and 3% of adults with a bachelor’s degree had below basic health literacy.

The real importance of all this information is that, as one might expect, individuals with higher health literacy also self-reported better overall health.

When a woman struggles to understand directions from her physician, the chances of successfully managing a chronic illness are lower. When a man is unable to read a chart showing the healthy weight for his height and age, he may not realize he is moderately overweight and will be less likely to consider lifestyle changes. When a mother does not understand the dosage instructions for her child’s medication, she is less likely to foster a quick recovery and may even make a grave error. When a young man does not understand his insurance plan, he may not realize that he will pay significantly more to get a couple of stitches at the emergency room as compared to a local urgent care clinic.

Provider-patient interaction, disease prevention, and navigation of the health care system all contribute significantly to the health outcomes of individuals, as well as the cost of our overall health care system.

So how should we respond to these results about health literacy? What can be done to improve the health literacy of our population and to make navigation of the health care system more manageable?

One step that has already been taken by President Obama is the Plain Writing Act, which was signed into law on October 13. This act requires federal agencies to write all public documents in a “clear, concise, well-organized” manner. This includes Medicare and Medicaid forms! (Although I supposed "clear, concise, and well-organized" is mainly in the eyes of the writer.)

Many non-federal agencies, such as pharmaceutical and insurance companies, are also encouraging the use of plain language. This does not mean that the company “dumbs down” concepts, but that it uses common vocabulary and more streamlined structures of communication to state the same information.

Compare the following:

A. The Dietary Guidelines for Americans recommends a half hour or more of moderate physical activity on most days, preferably every day. The activity can include brisk walking, calisthenics, home care, gardening, moderate sports exercise, and dancing.

B. Do at least 30 minutes of exercise, like brisk walking, most days of the week.

Option B is clearly in plain language compared to option A, and they communicate the same essential point.

Another idea to improve health literacy is to incorporate additional skills into existing health education classes (such as those that cover sexual health in middle and high school.) These could include the basic skills of reading health-related articles, filling out health forms, understanding medication instructions, and learning basic insurance terms, like “deductible” and “copay.”

It may also be helpful to provide more extensive literature and/or classes for health care professionals on communicating with health literacy in mind. Since I am not a health care provider, I do not actually know what sort of training physicians, pharmacists, and other providers receive in this area already. It might even be helpful to train the secretary or office manager at the front desk of a doctors’ office.

Many hospitals and insurance companies may also benefit from amplifying the role of personal phone calls from nurses in following up with patients. A three minute call may reveal that a patient is not following post-operation instructions or has questions about medication side effects that can be answered right away, which may or may not have come up before the patient returned home. This sort of pro-active approach offers a patient the opportunity to get further clarification on any instructions or ideas they did not understand originally. And it can prevent unnecessary complications or readmissions to the hospital.

Some communities already have nonprofit organizations, which help individuals navigate the health care system, particularly the application processes for Medicare and Medicaid. If the government, doctors, hospitals, and insurance companies collaborated with these organizations, they could potentially support classes that introduce members to basic health literacy concepts. Or they could more generally glean information from the nonprofit’s experience about the most common areas of difficulty and use the information to make document and process changes.

I am very interested to know if others have ideas that they think would improve health literacy or that would make the health care system easier to navigate. Please share!

Photo Credits:

• http://socialmarketing.blogs.com/r_craiig_lefebvres_social/2007/02/health_literacy.html
• http://www.aaaceus.com/courses/NL0610_overview.asp