Higher Education Is a Public-Health Issue
By GORDON K. DAVIES, president of the Kentucky Council on Postsecondary Education
Higher education has an enormous responsibility for our society's well-being. Policy makers often highlight higher education's critical importance to local, state, and national economies. Education beyond high school is now a necessity for most people who aspire to be financially secure.
Yet beyond their economic contributions, colleges and universities play another closely connected but often overlooked role -- one that is gaining new urgency. Education determines not only earning capacity but also the very quality of human life. Even longevity is correlated with educational achievement. In the broad sense of how well we live our lives -- both individually and collectively -- higher education is a public-health issue.
My home state of Kentucky -- and, I suspect, every other state -- has its regions of poverty, children trapped in bad schools, adults who lack the skills needed to earn a decent wage, chronic patterns of behavior that lead to debilitating diseases, and clusters of people without a shared purpose to unite them as communities. Underlying the differences among the states are common public-health needs. Higher education is an essential part of the cure.
Try this in your state: On a map, identify counties, cities, or regions that have major educational problems such as large numbers of students dropping out of high school or small percentages of that population attending colleges. Overlay that map with another that identifies areas with low per-capita income and high unemployment. Add another map showing excessive concentrations of above-average rates of lung cancer and coronary disease, then another indicating excessive concentrations of infant mortality and children living in poverty.
In Kentucky we found, not surprisingly, that the maps overlapped significantly. Chances are, your state has similar overlaps. Education, or lack of it, relates to every other social issue.
The ability to put roses as well as bread on the table is essential to a full life. Parenting and other personal relationships, civic and community involvement, creation and use of leisure time, care of self and loved ones, the ability to do one's work and comprehend its meaning in society -- reasonable competence in at least most of these things is essential to our personal and collective health.
Those of us with more education tend to have higher incomes and can afford better health care and insurance. Higher education also gives us greater awareness of how we and our children can be healthy and reduce risks. For example, we know from medical research that better-educated women have easier pregnancies and are apt to bear healthier children. We also know that they receive better medical care.
Educated people know how to change their behavior. Harry Carloss, the outgoing president of the Kentucky Medical Association, observed in the association's journal that the five-year survival rate of college-educated patients with breast cancer is double that of those who lack a high-school diploma. Education, he concluded, influences all conditions in which behavior modification can yield positive results. Confidence, self-reliance, and adaptability are all earmarks of advanced education.
Research shows that a strong contributing factor to a child's ability to read is parents who read with her. Studies also demonstrate that the single strongest predictor of whether a young person will go to college is that her parents attended.
Kentucky is working hard to overcome severe educational deficits. Almost one-third of ninth-graders drop out by the end of12th grade. Only about half of those who graduate from high school go on to college. Of the people who enroll in Kentucky's public universities, barely 4 in 10 graduate within six years. The ratio of engineers and scientists to the general population is among the lowest in the nation. Almost 1 million people in the workforce of 2.4 million have trouble with reading and arithmetic.
Kentuckians also tend to be unhealthy. They suffer disproportionately from diabetes, heart disease, and cancer. They have myriad bad health habits that cause or contribute to illness. We are, for example, second among the states in the percentage of adults who smoke. A survey conducted by the University of Kentucky in 2000 showed that the probability of smoking is inversely related to educational achievement.
The educational deficit and generally poor health among Kentuckians affect communities, families, and individuals. For more than 20 years, Kentucky's per-capita income has remained at about 81 percent of the national average, among the lowest in the nation. But that isn't just a matter of money. It also is a matter of personal and community well-being.
Building strong colleges and universities does not lead automatically to a healthier citizenry. When Kentucky began its ambitious reform of postsecondary education in 1997, the state ranked 40th in Kids Count, the annual assessment of how well children are doing in the United States. But just ahead of Kentucky, in 39th place, was North Carolina, a state that has one of the nation's best systems of higher education as well as a good community-college system.
It is possible to build and maintain fine educational institutions while disregarding the condition of children. Indeed, it is possible to build them while not responding to the needs of children and others who are voiceless and easily ignored.
For example, Kentucky's spending on higher education is very high -- 12th among the states per full-time-equivalent student in 1999. But by most indicators of personal and collective well-being, we rank among the bottom 10 states. The reform effort now underway challenges us to improve the return on the state's investment. If we cannot, perhaps public money should be spent on services other than higher education.
Higher-education institutions already improve the general health of communities and individuals in many ways. Colleges and universities train physicians and other health-care professionals. They operate clinics in remote regions of every state, and participate in efforts to vaccinate children and ensure that they have health insurance. They help farmers find alternatives to crops like tobacco and increase the efficiency of small farms. They provide incubator space and management advice to small businesses.
But the needs are much greater. We should help parents and future parents become more self-reliant, skillful, and capable of raising children who expect to go to college and are prepared to do so. We should offer education that provides adults with the skills and knowledge they need to prosper in a technologically advanced economy. And we should reward faculty research that can be transformed into new industries and better jobs in our states.
If we build great universities and do not at the same time help improve the lives of every woman, man, and child -- even those who do not participate in advanced education -- we shall have failed. We shall have built our castles in a bog.
We should not turn our colleges and universities into social-service agencies. But we do need to recognize publicly that advanced learning is a key ingredient of personal and community health. We know that state health agencies cannot wait passively for parents to bring their children for vaccinations; too many never make it. We should be no more complacent about large numbers of students dropping out of high school or not going on to college than we are about vaccinations. Our state policy should be zero high-school dropouts and 100 percent participation in some form of advanced education among recent high-school graduates.
We can't sustain economic growth based on technological sophistication if one-third or more of the adult workforce reads, writes, and computes poorly, if at all. We can't sustain a democratic, participatory form of government if large numbers of African-American, Hispanic, and poor white students drop out of school before they have learned how to be good citizens.
If we focus only on results within our immediate control, we shall miss an opportunity to transform our society. Those of us in higher education possess a moral authority that enables us to lead society on crucial issues. Colleges and universities are the best institutions to accept responsibility for public health in the broadest sense.
In his 1876 inaugural address as the first president of the Johns Hopkins University, Daniel Coit Gilman predicted that the advent of the modern research university would lead to "less misery among the poor, less ignorance in schools, less bigotry in the temple, less suffering in the hospital, less fraud in business, less folly in politics." Gilman's vision is easy to dismiss as a naive expression of 19th-century liberalism. But it also is a generous and courageous statement of the social responsibility of colleges and universities in a democratic society. Cynicism about such lofty goals as reducing the folly in politics should not blind us to the great contributions higher education has made -- and should continue to make -- to improve the public health.
As the most privileged institutions of our society, colleges and universities should reaffirm and work toward achieving Gilman's vision. We need educational leaders who assert that the health of individuals and communities -- the public health -- is the responsibility of their institutions, and who help faculty members and administrators achieve a broader vision of what advanced education has come to mean in our world.
- First, we should become much more involved in preschool, elementary, and secondary education. Because decisions made early in life profoundly affect later opportunities, we should acknowledge every young person as too valuable to waste and treat each as a potential learner. We should fill in the ugly ditch between high school and college so the transition is not an obstacle to continued learning. We should invest more time and energy in preparing teachers and improving the status of teaching as a profession.
- Second, we should help educate the tens of millions of adults who can't read well enough to follow the instructions of a family physician, who barely qualify to work in the fast-food industry, and who lack the capacity to adapt their behavior when the conditions of their lives change because of illness, job loss, or countless other incidents. We should reach out to people who are isolated by geography or personal circumstances. For example, Kentucky is using its Virtual University to fight adult illiteracy and train 911 operators and volunteer firefighters, as well as to make the collections of every college and university library accessible to patrons of public libraries throughout the state.
- Third, we should affirm and demonstrate within the curriculum the practical value of learning. We should require all students to participate in community service that is relevant to their programs of study. We should remind society -- and ourselves -- that politics and economics are best understood in the context of the classic philosophical debate about how to live the good life.
- Above all, we should model the behavior we want. Students often experience a curriculum that is very different from the one we think we are teaching; they learn more from what we do than from what we say. Leaders who are willing to be judged on whether the quality of lives actually improves as a result of theirefforts, not just on whether they have cracked this or that elite ranking, will make an enormous difference.
Helping improve public health is important because it's practical and necessary, not just because it's the right thing to do. State governments that invest in higher education should expect returns on their investments that transcend the institutions themselves: healthier individuals, social institutions, and communities. Wilhelmina Delco, now retired from the Texas legislature, used to say that state investments in higher education had to make a difference to all citizens, whether they attended college or not.
"Perhaps we cannot make this a world in which children do not suffer," wrote Albert Camus. "But we can lessen the number of suffering children. And if you and I do not do this, who will?" That is the challenge of seeing higher education as a public-health issue.
This article is from The Chronicle of Higher Education (http://chronicle.com) From the issue dated November 30, 2001.