In public health we are constantly reminded that our healthcare system and the Affordable Care Act can only do so much to get and keep our nation healthy. Unless we positively impact and shape the social determinants of health – or the wider forces and systems shaping conditions of daily life, such as where we are born, work, live and age – we most likely will never see the cost-savings and long-term positive outcomes the ACA promised.
If I could identify one key strategic area to influence that can be a game-changer to positively disrupt social determinants of health, it would be education. Because only through a partnership with education can we change the fundamental condition that negatively shape healthcare costs, namely poverty. While health and education are constant concerns for most people, the connection between the two is not always obvious, and it is more often identified by healthcare providers, not educators.
So what can educators learn from healthcare? In a city like Philadelphia where only half of students graduate high school, education has to ask itself what it is doing wrong, and what it can do differently.
As in healthcare, you cannot properly educate someone unless you diagnose their needs, styles and learning challenges, before you treat – or educate – according to these needs. As a parent of 14-year old son with double-deficit dyslexia, and a volunteer who has worked with hundreds of families in similar situations across the state of Pennsylvania, I have seen first hand how our public school system fails to diagnose these needs. And, even when there is a diagnosis, the treatment – or education – lacks individualization.
The medical profession is driven by proven interventions depending upon a diagnosis. The education profession is driven without proper diagnosis, and therefore lacks informed judgment on the best interventions.
The consequence of a one-size-fits-all approach is that 51% of students in the Philadelphia public school system fail. Imagine if 51% of patients died? Offering the proper diagnosis and treatment could make the difference for the 51% of struggling learners to lead an educated, successful and healthy life. Instead, these kids fall behind in public schools and many end up in poverty or in our criminal justice system, all because we failed to diagnose and treat a simple issue like dyslexia.
This flawed approach is not because of ill will; on the contrary, school districts don't have the proper human resources to execute upon effective interventions and standards for students who have specialized education needs. And I can't blame educators, many of whom are passionate about seeing their students succeed. Educators are not taught to diagnose students, and even if they are provided with a diagnosis, they are not given any guidance or direction on how to differentiate and individualize their intervention.
As a parent and advocate, I want to help schools and educators get the resources they need. But the fact remains that inaction to create smart changes is equivalent to a pediatrician ignoring a chronic condition diagnosis if treatment is not reimbursable. Ultimately, this leads to consequences that spin out of control and cost the system more than treatment would have in the first place.
What's the lesson here? Education and healthcare must align. Good education starts with a diagnosis, and then appropriate individualized interventions. Without good education, the health sector will continue to face social determinant roadblocks to making all patients healthier.
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