In a recent op-ed in the San Francisco Examiner, William Dow, a professor of health economics at UC Berkeley, commented on the importance of education as a means of enabling more people to afford health care insurance. In my view, education is important not simply because an educated population can more easily pay for health care. The main importance is that educating children will allow those children and their children to have healthier childhoods, less burden of disease as adults, access to more personal and communal resources to deal with whatever disease they have and less need for health care, and that translates into less health care spending. Let me frame this in terms of the San Francisco Bay Area.
In a series of articles in the Contra Costa Times last year, Susanne Bohan and Sandy Kleffman described the striking differences in life expectancy in poor vs. wealthy ZIP codes in East Bay. Life-expectancy in Walnut Creek (94597) was 87.4 years, but it was only 71.2 years in Sobrante Park (94603), where household incomes are about half and poverty >20%. That’s a gap of 16.2 years. We find that, in addition to a shorter life-expectancy in Sobrante, the inpatient hospital utilization rate is double the rate in Walnut Creek. Poverty is not only tragic. It’s expensive.
Bayview/Hunter’s Point is poor area that’s across the Bay in San Francisco. In an article in last month’s New Yorker about Nadine Burke’s clinic for the poor in Bayview/Hunter’s Point, Paul Tough described the community as “a bleak collage of warehouses and one-story public housing projects.” Like Sobrante Park, its poverty rate is >20%, double San Francisco’s average, and hospital utilization in Bayview/Hunter’s Point is double the rate of San Francisco’s wealthy areas, such as Marina and Twin Peaks.
Now let’s look at education. In Sobrante Park and Bayside/Hunter’s Point, where life is short, health care spending high and poverty prevalent, only 40% of adults completed high school and only 5% achieved bachelor’s degrees. In contrast, in Walnut Creek, Marina and Twin Peaks, where lives are long, poverty rare and spending low, >95% completed high school and 40% have bachelor’s degrees. These high-education areas resemble Japan, where high school completion rates are also >95%, as they have been for decades, and where life expectancy is best and health care spending is least.
So I agree with Professor Dow. While other factors contribute to high health care spending, poverty contributes the most, and if the goal is to control health care spending, we must educate children. Of course, they will need more than good schools. They’ll need safe neighborhoods, adequate nutrition, a nurturing environment and more. But without vast improvements in how poor children grow into adults, constraining health care spending will remain a distant dream.