Saturday, July 12, 2014
Inquirer Daily News

Could education equal medication for treating chronic disease?

One study finds 52 percent higher mortality among diabetics who didn't take medication. Another finds 52 percent higher mortality among diabetics who didn't finish high school.

Could education equal medication for treating chronic disease?

South Philadelphia High School: A major medical institution?
South Philadelphia High School: A major medical institution?

Matt O’Brien is an assistant professor of medicine and public health at Temple University and a founder of Puentes de Salud, a health center serving immigrant Latinos in South Philadelphia.

By Matt O'Brien

Almost six months ago, at a community meeting in South Philadelphia, I heard the following story, one that tragically illustrates a powerful connection between education and health:

A 17-year-old girl, born in Mexico and brought to Philadelphia as a young child, took her life — in large part because she saw no opportunity to pursue a college education after graduating from South Philadelphia High School, a milestone that she would have reached this coming June.

Like almost 65,000 other undocumented immigrants graduating from U.S. high schools every year, this young woman was not eligible for federal loans and grants, which are the largest source of financial aid for college students. Without tapping such federal funds, most undocumented families are poorly positioned to afford the enormous sticker price of a college education.

This story represents an extreme and very direct example of how limited educational opportunities can threaten the health of individuals and communities. Researchers have uncovered a more insidious link between education and health, or the flip side of the same coin — low levels of education and illness. One recent study of adults with diabetes showed that those with less than a high school education died at higher rates during a 10-year period than college graduates. After controlling for many factors that may impact mortality, diabetic patients who did not graduate from high school were 52 percent more likely to die compared to their their counterparts with a college education.

In order to understand this number — 52 percent higher mortality — I turned to the medical literature on diabetes treatment. Metformin is our first-line medication for treating diabetes and is one of the most widely used diabetes drugs worldwide. In the landmark randomized trial that established its effectiveness, there were 20.6 deaths (per 1,000 patient-years) in the placebo group that received no active medication, compared to 13.5 in the group that took metformin. This study’s randomized design ensures that the participants who took a placebo pill and those who took metformin had equivalent levels of education. Therefore, the participants’ educational attainment did not impact the findings. Looking at the numbers above more carefully, we find that mortality in the placebo group was 52 percent higher than was mortality in the group that took the medication.

Connecting the dots from above, we see that a college education (first study) had exactly the same effect on reducing mortality among diabetics that taking metformin (second study) did. Stated differently, a full dose of college education was equivalent to medication at preventing death among adults with diabetes.

These two studies illustrate a very important reality that has been largely ignored in the current health policy debate—that improving our nation’s educational system will also improve the nation’s health. One may ask if this relationship between education and health is specific to diabetes, and the answer is clearly “no.” In fact, there is a strong tie between educational attainment and health for each of the other leading causes of death in the United States: heart disease, cancer, emphysema, stroke, accidents, Alzheimer’s disease, influenza/pneumonia, and kidney disease. Given the breadth of health problems that can be improved by simply educating our population, it is a wonder that the health policy debate has eschewed education in its exclusive focus on medical treatments provided by doctors and other health professionals. Following this robust body of evidence, our elected officials may want to consider the health rewards that could result from improving educational opportunities for young people both locally and nationwide.

This brings us back to the young South Philadelphia woman who took her life because she felt she would not have the opportunity to pursue her dream of going to college. Sadly, not only would attending college have lowered this young woman’s risk of eventually dying from each of the nine leading causes of death in the U.S., it also would have decreased her chances of dying from the 10th leading cause of death: suicide.


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What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, DrPH, MPH Research Director, Drexel Center for Nonviolence and Social Justice
Janet Golden, PhD Professor of history, Rutgers University-Camden
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