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By Athena Mandros

Over the past couple of weeks, we’ve focused on the relationship between health and social conditions – when individuals can’t meet their daily needs, their health suffers (see Poverty Really Does Matter When It Comes To Health Care Spending, From 5:95 To 1:99, Tending To The Social Determinants Of Health – Or Not). And we have talked about the social services that consumers can access to help meet those daily needs, such as SNAP, WIC, TANF, and SSI (see Helping The Consumers Who Need Income Assistance Navigate SSI & SSDI, Getting SSI Income Assistance For Consumers With Disabilities, Helping Low-Income Consumers Access The Resources They Need, and Helping Consumers With Food Insecurity: What Services Are Available?).

But there is one important social determinant of health that we haven’t yet addressed – education. Education does not refer specifically to health education, but to educational attainment in the school system, such as completion of high school or college. And its effect on health can be expansive.

First, individuals with higher levels of education have a higher life expectancy and are less likely to have poor health status. “Remaining life” expectancy at age 25 is 10 years shorter for people who do not have a high school degree compared with those who have completed college (see The Effect Of Educational Attainment On Adult Mortality In The U.S.). And by some counts, 145,243 deaths could be saved per year if adults who had not completed high school went on to earn a GED or high school degree, and 110,068 deaths could be saved if adults who had some college went on to complete their bachelor’s degree (see Education And Mortality Study Finds Association Between High School And College Education And Life Expectancy).

Another important hallmark of education – literacy – has a large effect on population health. A 2003 survey found that 30 million (14%) U.S. adults didn’t have the literacy levels needed to “perform simple and everyday literacy activities” – and the proportion of adults with below basic health literacy ranges from three percent of college graduates, to 15% of high-school graduates, to 49% of adults who have not completed high school (see Education and Health).

Educational attainment also directly correlates to earnings. In 2015, the median weekly income for an individual with less than a high school degree was $493. For an individual with a high school degree, earnings jumped to $678. Earnings then nearly doubled for an individual with a bachelor’s degree, at $1,137 (see Employment Projections). Higher income and earnings result in food security, safe housing, less stress, and the ability to exercise, which can also result in better health (see Why Education Matters to Health: Exploring the Causes).

Education helps individuals develop skills, learn to problem-solve, and develop personal control. Individuals with lower levels of educational attainment are less likely to have these skills, which subsequently affects their health. For example, less education is associated with less personal control over factors such as employment, income, and living situations. This lack of personal control can also lead to a lack of efficacy in effecting personal health outcomes. For example, individuals with lower income are more likely to engage in smoking and risky behaviors (see Understanding the Relationship Between Education and Health and Education and Health). Additionally, lower levels of education are more likely to result in long-term stress and individuals are less likely to have a social support system or the necessary skills to cope with stress leading to chronic illness (see Understanding the Relationship Between Education and Health).

Finally, higher levels of education also allow individuals who have chronic conditions to manage them better. For example, 15% of females with a high school diploma or less, died from diabetes compared to 10% of females with a college degree (see Health Care: Necessary But Not Sufficient). Studies have found that individuals with lower levels of education may have difficulty adhering to medication regimes and interpreting health messages. Furthermore, physicians are more likely to engage and better explain health issues to patients that ask questions and encourage open communication – which is largely attributed to educational attainment (see Understanding the Relationship Between Education and Health).

What does this information mean for provider organizations? As we move to value-based reimbursement, getting “value” will involve consumer engagement. First, know your consumers. Consumer engagement approaches need to be customized to the education level of the consumer. Consumer health education and consumer engagement in health management need to be appropriate to both the consumer’s level of education and consumer demographics – what works for one population may not work for another. Research shows that younger consumers, those with high incomes, and those with private insurance are more likely to be actively involved in managing their health care and may not need as intensive communication and follow-up as populations that are older and/or less educated. Consumer levels of activation also vary by diagnosis — among consumers with chronic conditions, those with cancer tend to be the most engaged, while those with depression are the least engaged. This means that provider organizations need to tailor their consumer engagement strategies based on specific populations, with customized tactics for each group.

Second, assist with care coordination and access. The health care system is complex and can be difficult to navigate, but research suggests that engagement at the provider-level is most important for getting consumers involved in managing their own health care, particularly through the form of patient-centered medical homes or dedicated staff that encourage patient self-management. Consumers who have unmet medical and prescription drug needs or have delays in accessing care report the lowest levels of engagement. This means provider organizations need to take an active role in helping consumers navigate the health care system and access the services and supports they need (see How Engaged Are Consumers In Their Health And Health Care, And Why Does It Matter?).

Finally, give consumers options. Data shows that most consumers want to be more involved in their health care, but they need different paths. Research from Deliotte also suggests that consumers want to partner with their provider for care, but that they also want to be able to find health information online and have access to health care technologies that monitor health (see Health Care Consumer Engagement No “One-Size-Fits-All” Approach). Provider organizations should consider different methods of communication (including phone, email, texts, online consumer portals, etc.) and give consumers different tactics for monitoring their health and engaging in treatment – from something as simple as encouraging and reminding consumers to develop a list of questions to bring with them to their appointments, to using a smartphone app to track their symptoms and then sharing that information with their clinician.

For more on achieving those goals, check out these resources from the OPEN MINDS Industry Library:

  1. For Tech-Enabled Consumer Health Education, Engagement = Success
  2. Building Your Own Tech-Enabled Consumer Base
  3. Consumer Focused? Think Mass Customization
  4. Will Your Consumers Miss You If You Are Gone?
  5. The Emerging Group Of ‘Active’ Consumer Technologies
  6. The Soon-To-Be Consumer-Facing EHR

Provider organizations may need to spend more time explaining health issues, medication regimes, and the effects of a healthy lifestyle with these consumers. Essential to providing whole person care is understanding consumers of diverse educational backgrounds and varying degrees of health literacy.

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