A Paradox of Well-Being

by Charles Fazio, M.D., and Thomas Kottke, M.D.

We’re spending more on health care — and, as a result, less on things that can help stop  illness before it start

Ready for a quick health quiz? On average, which has the strongest association with longevity: screening for breast cancer, controlling cholesterol, treating high blood pressure or graduating from high school?

Not many people guess “diploma,” but if you did, you’ve aced the test. According to the National Institutes of Health, not finishing high school can be about as bad for your longevity as 30 years of cigarettes. In fact, lack of education seems to be one of the reasons life expectancy is regressing — and fast — for some groups in the United States.

Consider: Life expectancy for white women without a high school diploma fell five years between 1990 and 2008. Other studies suggest evidence that lives of the less-educated seem to be getting shorter. Or, to be more upbeat, there’s likely a stronger association between education and good health than we may have thought, and we can use that realization for the good.

The reasons make sense. The more highly educated can compete for better-paying jobs. They can afford healthier foods and homes. They face less stress and uncertainty, and they tend to have healthier lifestyles. Importantly for the community, studies show they’re also more likely to be employed and self-sufficient. Education is clearly a powerful driver of health and well-being.

But there’s a paradox. Investment in education is being crowded out, aggressively, by health care spending.

In Massachusetts, for example, inflation-adjusted spending on health care increased a staggering 81 percent during the past 15 years, while spending on early-childhood education fell by 27 percent. Minnesota’s numbers are similar. In 2008, consultants to the state predicted that in each of the subsequent 25 years, health care costs would grow by 8.5 percent, revenues by only 3.5 percent and education by 0.2 percent.

There’s more paradox. Research shows that clinical care — those services in hospitals and clinics that are projected to rise 8.5 percent per year — contributes only about 20 percent to how healthy we are. The other 80 percent? Along with education, it comes from nonclinical things such as good jobs, healthy behavior choices and a good environment — all of which suffer because of cutbacks to pay for health care.

The upshot? The more we spend on health care, the less we have to spend on things that have the most power to promote healthy, long lives. It’s a bad spiral, but we can reverse it. We all have a part to play:

• Clinicians and health care providers: We need to speed efforts to remove waste from health care. The industry should commit to lowering health care cost trends to the level of general inflation, or below it, within five years.

• Education: Starting even before a child is born, and from birth through high school, families, schools and communities need to be close partners in education.

• Health insurance companies: Continue and accelerate payment reform so we’re paying for results rather than volume. At the same time, support new incentives to reward the elimination of racial and financial-class disparities in health outcomes over the next five years.

• Patients and physicians: New shopping and transparency tools can help you compare care and choose wisely. See how you might achieve good results with less-expensive tests or treatments — as consumers now do routinely by choosing generic drugs.

• Communities: Continue to forge and strengthen private-public partnerships that promote health. Invest in resources, for example, that enable and encourage walking and biking; promote access to healthy foods; reduce exposure to tobacco smoke, and increase worksite well-being and safety.

• Everyone: Engage in healthy behaviors and recruit your family and friends to join you. Educate yourself on the simple behaviors that have the greatest impact: be tobacco-free, eat lots of fruits and vegetables, do physical activity daily, use alcohol responsibly, have healthy sleep and healthy thinking.

Does it surprise you that two medical directors would write a commentary about education advocacy? Or would it surprise you to hear of pediatricians taking time during appointments to promote literacy and the value of reading aloud to children or other nonmedical factors of health?

It shouldn’t, because this is our community, too. And our focus has never been only health care; it has been about health. With shared commitment and like-minded partnerships in our community, we’re optimistic that every Minnesotan can have a strong education, the health care they deserve and a healthier, happier life.


Dr. Charlie Fazio and Dr. Thomas Kottke are medical directors for the HealthPartners health plan. This blog originally appeared in the Star Tribune