Income and Education Are Bigger Determinants of Health Than Insurance, Report Shows

By Maggie Mahar, Health Beat. Posted October 20, 2008.

This story originally appeared on Health Beat.

The Robert Wood Johnson Foundation's Commission to Build a Healthier America has just released a report that reveals the degree to which a child's health is determined by the hand he or she draws at birth.

The report, which is titled "America's Health Starts With Healthy Children: How Do States Compare?" confirms what we have written in other Health Beat posts.

While having or not having health insurance is important, poverty will have an even greater influence on an individual's health. As Commission Co-Chair and former Congressional Budget Office director Alice M. Rivlin puts it, "This report shows us just how much a child's health is shaped by the environment in which he or she lives." 

Moreover, the report reveals that it is not only the poor who are molded by their environment. "In nearly every state, children in middle-income families also experience shortfalls in health when compared with those in higher income families. And these differences in children's health by income can be seen across racial or ethnic groups"  says the report, which is based on  research  done at the University of California at San Francisco's Center on Social Disparities in Health. Ultimately, this study highlights "the unrealized health potential possible if all children had the same opportunities for health as those in the best-off families."

"Most of our efforts to improve health have focused on improving quality, access to and affordability of care. While these are important, support for better health that is associated with resources and community matters as well," says Commission Co-Chair Mark McClellan. "As a nation, we clearly need to do better...a large body of research shows that the causes [of poor health among children] are complex," the report observes, "and that medical care interventions are important but not sufficient."

To illustrate "the magnitude of the link between education and health" the Commission also is releasing a new online tool that lets viewers see the connection first hand, says Dr Steven Woolf, a professor of Family Medicine at Virginia Commonwealth who was involved in developing the tool. (Readers who want to check the relationship between education and premature deaths in their state or country will find the tool here).

How the Study Measures Income and Education

Taking family size into account, family income is categorized by comparing it to Federal Poverty Level (FPL), which has been defined as the amount of income that will provide a bare minimum of food, clothing, transportation, shelter and other necessities. In 2006, the U.S. FPL was $16,079 for a family of three and $20,614 for a family of four. Children were considered to be poor if they lived in households below the FPL, "near poor" if they lived in homes that fell somewhere between the FPL and twice the FPL (for a family of three that would be somewhere between $16,079 and roughly $32,000) "middle income" if they lived in households with income somewhere between twice and three times the FPL (or between $32,000 and $48,000), and "higher income"  if they lived households earning four times the FPL or more ( over roughly $64,000 for a family of three, $80,000 for a family of four.)

To measure education while examining children's general health, the report looks at the highest level attained by any person in the household using four categories (less than high-school graduate, high-school graduate, some college, and college graduate).

In the U.S. 18 percent of children live in households that are "poor' and another 19 percent in households that are "near poor." Thirty-two percent are in middle-class homes, and just 28 percent live in "higher income" homes.  Only 9 percent are growing up in households where no adult has completed high school, 24 percent live in families where at least one adult is a high school graduate, 32 percent in homes where one adult has some college, and 35 percent in homes where at least one person is a college graduate.

Just How Much Difference Do Income and Education Make?

In the United States, 16 percent of children ages 17 and younger are in less than optimal health -- a rate that varies widely across states from a high of 22.8 percent in Texas to a low of 6.9 percent in Vermont. (Assessment of a child's health is based on parents' reports; researchers ranked a child's health as "less than optimal" when parents described it as "poor," "fair" or "good" -- but not "very good" or "excellent." )   

See more stories tagged with: health, environment, education, health care, poverty, health insurance, income

Maggie Mahar is a fellow at the Century Foundation and the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006).

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