High School Graduation is Public Health ROI
Terri WrightTerri D. Wright is the director of the newly established Center for School, Health & Education Division of Public Health Policy and Practice at the American Public Health Association. She will provide leadership to the strategic development and integration of public health in school-based health care and education. She recently retired from the W. K. Kellogg Foundation in Battle Creek, MI where she served for 12 years as a program director for health policy. In that capacity Terri developed and reviewed the Foundation’s health programming priorities and initiatives, evaluated and recommended proposals for funding, and administered projects and initiatives. She also assisted in public policy analysis and related policy program development, as well as provided leadership to the Foundation’s school-based health care policy program. Previously, Terri was maternal and child health director and bureau chief for Child and Family Services at the Michigan Department of Community Health in Lansing, Michigan. In that role, she managed policy, programs and resources with the goal of reducing preventable maternal, infant, and child morbidity and mortality through policy and programming. She received her bachelor’s degree in community and school health, as well as her New York State certification in secondary school education from the City University of New York and her master’s of public health degree in health planning and administration from the University of Michigan in Ann Arbor. She is currently a doctoral student in public health at the University of Michigan. Terri takes an active leadership role in several professional associations and community organizations including the American Public Health Association and the Institute of Medicine’s Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities.
When asked by a potential community partner what was the one thing that could be done to improve the health of its citizens, Dr. Adewale Troutman, the then newly appointed director for Louisville’s health department* answered, “to make sure that everyone graduates from high school”. Like many others, the community partner wondered – what does high school graduation have to do with health?
Graduation from high school is the leading health indicator for adults, even when controlling for race and income. Although a college degree is additive, completing high school increases the likelihood of practicing health promoting behaviors, experiencing better health, living longer, and reducing the incidence of mortality and sickness in offspring. By contrast, students who drop out of high school are more likely to die at younger ages as adults from chronic conditions such as cardiovascular disease, cancer, infection, lung disease, and diabetes, than their peers who graduated. Most of those who drop out of high school do not have health insurance and have limited access to health care. And the children of mothers who drop out are twice as likely to die before age 1 and six times as likely to suffer from poor health all their lives, if they survive.
The expanse of American kids dropping out of school before they graduate is well documented. Although the number is decreasing, every 26 seconds a student drops out. Approximately 6000 students daily are pushed out, pulled out or just give up on school. Dropouts face economic obsolescence as adults, strain the GDP, and have great difficulty assisting in the educational success of their own children. As with health disparities, the odds of dropping out of school are disproportionately stacked against poor students of color – about a third will not graduate from high school with the greatest risk attributable to African-American boys. Half of them will not graduate with their ninth grade class. Many will become a juvenile justice statistic.
So again one may ask – what is the role of health to high school graduation? Many of the conditions that influence attendance, behavior and academic performance are correlated with whether or not students are healthy, engaged and safe. Unmet physical, mental, and emotional health issues including – asthma, vision deficiencies, hunger, pregnancy, repeated exposure to traumatic stress such as violence and other poverty-generated factors will impact a student’s ability to succeed academically.
The pathways to and consequences of drop out perpetuate an insidious cycle of poverty, disparities and entrenched inequities that underscore why graduation has become a public health priority. It is therefore fitting that Healthy People 2020 (Department of Health and Human Services) includes a graduation objective for health. For surely, if the goal of public health is to prevent disease and promote health, “making sure everyone graduates from high school” assures a public health return on investment.
As we wrestle with healthcare delivery, school reform, gun control and the other important issues of our day, could it be that we are sometimes penny wise and pound foolish? Why wouldn’t we hedge our “downstream” interventions with cost effective “upstream” prevention strategies that will yield the results we claim to want? For example, we know the efficacy of school-based health centers as a viable model of health care. That is why our Congress authorized them in the Affordable Care Act. Yet, they failed to appropriate funding for their operation despite the evidence that African-American males – the group at greatest risk for dropping out, unemployment, prison, chronic disease, lack of health insurance, or death by a gun wound – are three times more likely to remain in school when affiliated with a school-based health center. Rather than politicians, perhaps we should elect accountants who would know that high school graduation is public health ROI.
*Metro Louisville Department of Public Health and Wellness