Percentage with high school education or more
Education is linked to health outcomes in many ways. It provides individuals with knowledge and cognitive abilities to make healthier behavioral choices. It often leads to increased employment at higher income levels and in safer, healthier working conditions. It also provides social and psychological benefits, which increase problem-solving skills, teamwork, internal locus of control, social support, and other life skills that help people navigate risks and provide a foundation for improved health outcomes over a lifetime. Despite the complexity of the multiple factors that link education to health, staying in school to graduate is one of the strongest predictors of health, regardless of the school environment or the quality of the education. For these reasons, the high school graduation rate was chosen to best represent the effect of educational attainment as a SDOH.
Research demonstrates that educational attainment level is linked to a variety of health outcomes. Individuals without a high school diploma not only have higher incidences of risk behaviors (e.g., smoking, drinking), chronic disease (e.g., obesity, cancer, heart disease, diabetes), and other negative health outcomes (e.g., infant mortality), but they also have higher mortality rates and shorter lifespans compared with high school graduates. Health burdens due to low educational attainment disproportionately influence African Americans/Blacks, Hispanic/Latinos, and other race/ethnicities who are negatively affected by high dropout rates and the educational achievement gap. It is estimated that approximately 245,000 (10%) of the 2.4 million U.S. deaths in 2000 were attributable to low education. The mortality rates of high school dropouts 25 to 64 years are more than twice as high as those with some college education.
High school graduates earn more money than those with a general education degree (GED) or the same number of years of schooling but no diploma, which can lead to more access to resources and healthier work and living conditions. Earning a higher income provides the ability to purchase health care, have access to better housing and schooling, and engage in recreational activities, resulting in a better quality of life.
The causal relationship between education and health goes in both directions. For example, the mental and physical health of students and their families are major factors that affect the ability of children to learn and graduate. Studies show that children in poor health miss more days of school, have a higher likelihood of dropping out, and are more likely to become unhealthy adults. Some of the factors leading to school dropout are directly related to socioeconomic status. For example, students who work more than 20 hours a week to support their family, have low English-language proficiency, or who otherwise lack social or parental support are more likely to drop out than their peers.
In addition, because most public schools in the United States are funded by the assessed value of property (property taxes), schools in poorer communities often do not have the same resources to maintain a school climate that is as healthy and as conducive to learning as wealthier communities. Wealthier communities are able to provide other essential components of a healthy school climate beyond teachers and schools supplies, which include healthy food, opportunities for physical activity, and psycho-social support services. To be able to achieve academic success, students need to feed their brains and bodies with nutritious food options at school. Since many students consume more than half of their meals at school, it is essential that healthy options are readily available. When children consume healthy diets, optimal growth and development are promoted. When they eat a healthy breakfast, the associated benefits are improved mood, cognitive functioning, memory, and reduced absenteeism. A positive school climate has also been linked to students having a stake in caring for the school, as well as fewer behavioral and emotional challenges in students. This is because a positive school climate includes established norms and expectations that enable students to feel physically and emotionally safe and supported by those in their environment.
The methods to download data from the American Community Survey are in Appendix B. Census tracts with low educational attainment are identified using the Jenks natural breaks method in the map below. For example, this method identifies with red Census tracts in the city of San Pablo (Contra Costa County) as having low educational attainment. Therefore, this area should be designated as a priority area for further public health monitoring. The chart following shows changes in educational attainment for this city over time compared with the Bay Area. Trend analysis was conducted for San Pablo with the lowest overall educational attainment. From 2000 to 2007, the city experienced an increase in educational attainment, but returned to its 2000 level from 2007 to 2010. These changes are not statistically significant.
Figure 31: Educational Attainment, BARHII Region, 2006–2010
Figure 31: Educational Attainment, BARHII Region, 2006–2010
III. BAY AREA LOCAL HEALTH DEPARTMENT EXAMPLES
The CareCoaching 4 Sobrante Park Youth (SPY)–Action Project began in 2010 in response to the 60% high school graduation rate in Oakland Unified School District. The project addresses discriminatory beliefs, institutional power, social inequities, and risk factors as a way to encourage and promote educational attainment. In addition to the Bay Area Regional Health Inequities Initiative framework, project staff used several proven models to create an appropriate mix of services to meet the needs of the youth and implemented a program with four components: (1) care coaching—an intensive, one-on-one approach to assist youth participations with academic and social prerequisites for graduation and post-graduate plans; (2) skill-building educational workshops; (3) community engagement and positive role modeling; and (4) educational field trips. These services motivate youth to focus on their future and to ensure that they have the tools to successfully complete the program, earn their high school diploma, and create a plan to enter college or a vocational training program after high school.
Results of the project are encouraging. Five seniors who participated in the program all graduated high school and have a clear plan for after high school. Furthermore, 11 lowerclassmen identified a career that interests them through the intensive care coaching and workshops that were provided.
Since 2013, the Alameda County Public Health Department has leveraged lessons learned from the project and other youth interventions and brought economic development resources to expand and replicate the CareCoaching model countywide. For example, to provide psycho-social support, the project added a mental health specialist. Each youth is assessed by this specialist to identify psycho-social needs and offer appropriate support. In addition, the project supports the participant through continuous meetings with their principal, teachers, and family to develop, implement, and monitor plans to ensure well-being and academic achievement. The project is currently being piloted at the East Oakland Boxing Association, which helps Oakland youth achieve success in school, learn life skills, and build self-esteem in preparation for their future.
Chronic health conditions, especially asthma, often contribute to chronic absenteeism among students. The ACPHD Place Matters Criminal Justice Workgroup, the ACPHD Chronic Disease Program, and the Alameda County District Attorney’s Office created a case management component for the Alameda County truancy court—a court where the prosecutor, judge, and case managers work with parents of chronically absent children to improve school attendance. A process is now in place where judges can refer families with chronic disease issues to the county’s chronic disease program for case management. This has improved attendance. Asthma Start and partners are now exploring partnerships with local school districts to address truancy problems related to chronic disease earlier through a new project, Addressing Chronic Absenteeism. This effort aims to improve children’s health, reduce absenteeism, and improve children’s educational outcomes, which are directly linked to long-term health outcomes. For more information, visit http://www.acphd.org/asthma.aspx.
With funding from the W.K. Kellogg Foundation, ACPHD staff from Place Matters, the City–County Neighborhood Initiative, and the Community Assessment, Planning, and Evaluation (CAPE) Unit conducted a health impact assessment (HIA) on funding formulas for the Oakland Unified School District (OUSD). The HIA specifically looks at how modifying the current results-based budgeting formula to include a weighted student formula would decrease education inequities and the resulting health inequities.
The HIA considers different ways of addressing equity in school funding to improve academic performance through teaching quality, family and student engagement, improving access to health and support services at schools, and providing safer school environments. Staff presented this information to OUSD stakeholders, parents, and caregivers in the Oakland Housing Authority’s leadership program. They also provided the information to organizations that worked on passing a weighted student formula at for the state of California, which was successful in July 2013. For more on this HIA, visit http://www.acphd.org/social-and-health-equity/policy-change/place-matters/workgroups/education.aspx or http://www.healthimpactproject.org/resources/body/Brandon-ACPHD.pdf.
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