Introduction
It has been acknowledged that several social determinants influence people’s health. These social factors include income, race, unemployment, social support, and education, among others (Coughlin, 2019). Although multiple factors shape people’s behaviors and their health outcomes, education is one of the central domains that require specific attention as it can become an opportunity rather than a challenge. Education, as one of the social determinants, often has lifelong and far-reaching effects. The major outcomes associated with this social determinant are the prevalence of chronic illness, health behaviors, and shorter life expectancy in people with a low level of education (Alderwick & Gottlieb, 2019). This paper includes a detailed analysis of the impact of education access and quality on health equality and patient outcomes, as well as recommendations to improve the current situation.
Link Between Education and Health Equity and Patient Outcomes
The relationship between education and health equality and patient outcomes has been identified in numerous studies. For instance, the prevalence of diabetes in people with less than high school education is 12.6%, while the incidence rate is 7.2% among people with more than high-school education (Hill-Briggs et al., 2020). The diabetes-related mortality rate is twice higher in people with less than high-school education compared to those with a college education. Education is associated with the mortality rate, which is evident on the global level (see Figure 1).
Coughlin (2019) states that fewer African Americans gain high-school education as compared to non-Hispanic whites, 72.5% and 87.2%, respectively, which affects their income, employment, and access to quality health care. Coughlin (2019) notes that, as a result, the level of education predicts the survival rate of people with cancer. Other studies are consistent with these conclusions as, for example, it is found that individuals with less than a high-school education are at a higher risk (42% in men and 120% in women) of higher colorectal cancer mortality (Singh et al., 2017). Other chronic diseases are also more common in people with lower levels of education.
The prevalence of chronic diseases among people with lower levels of education is associated with health behaviors. It has been acknowledged that people with less than high-school education are more likely to have unhealthy behavioral patterns. Singh et al. (2017) note that approximately a quarter of people with such level of education are current smokers, while only 5.8% of those with a college degree smoke regularly. Medvedyuk et al. (2017) claim that the level of education is associated with such health conditions as obesity. The researchers state that education can be an effective platform to address the problem, which has been proved in various studies.
In addition to quite direct effects on patient outcomes, the social determinant in question affects healthcare accessibility. People with lower levels of education tend to have lower income, which, in its turn, makes quality healthcare services less attainable. These groups can hardly pay for their housing and daily expenses, so they tend to skip medical checkups that are critical for proper health management. Early diagnosis cannot be made if a person addresses a doctor when severe symptoms of an issue appear and their health has deteriorated substantially. The recent evidence of the role education may play in healthcare equity and patient outcomes have become the ground for the development and implementation of various incentives aimed at addressing the problem.
Reducing Health Disparities and Improving Health Equity by Addressing Education as a Social Determinant of Health
Numerous educational projects and initiatives have been implemented across the country. Harrington et al. (2020) claim that a two-fold approach can be instrumental in addressing the problem of health disparity and health equity. On the one hand, the increase in the number of healthcare professionals trained to provide high-quality healthcare services and advocate for vulnerable populations is necessary. The lack of nurses, as well as other practitioners, reduces health equity as people with higher income have higher access to health care. Underprivileged groups have to wait a long period before they can see a doctor or receive limited care due to the lack of time since healthcare professionals provide care to a large pool of patients.
Some programs aimed at addressing the shortage of medical staff have been introduced, and the practice is gaining momentum in rural areas. Federal and state budgets, as well as communities, fund projects that encompass the provision of scholarships to students of medical schools (Harrington et al., 2020). New healthcare practitioners, who choose to work in rural areas, receive additional benefits, including on-the-job training, which leads to the improvement of the quality of provided care. Alcaraz et al. (2019) claim that various policies addressing this issue have been launched and led to positive outcomes. In addition to popularizing medical professions, federal and state budgets allocate funds to provide scholarships to low-income students. By obtaining higher levels of education, these groups will be able to improve their socioeconomic status, which will make healthcare services more affordable for them.
On the other hand, more educational incentives in terms of the country’s educational system should be introduced. Educational facilities are seen as a favorable platform that ensures the coverage of a considerable population (Harrington et al., 2020). Therefore, healthcare professionals are involved in different programs launched in schools, colleges, and other educational facilities. A considerable bulk of evidence regarding different approaches and particular programs exists.
Researchers have developed guidelines and identified effective strategies and pitfalls to be avoided when creating projects aimed at addressing the social determinant in question. For instance, Alcaraz et al. (2019) state that targeted incentives should be implemented as they are instrumental in achieving clear and attainable goals. These projects are also cost-effective, which is critical for low-income communities. Students are trained to cook healthy meals, be more active physically, and maintain their mental health through the development of social ties. It has also been acknowledged that further research is needed to facilitate the development of the healthcare system and mitigate the negative effects of all social determinants, including education (Alcaraz et al., 2019; Harrington et al., 2020). Evidence-based initiatives should be carried out in different communities across the country with a focus on their peculiarities.
How Effective Quality Management Programs on Education Can Improve Health Equity and Patient Outcomes
Public health is one of the priorities of the American government, so diverse measures have been undertaken to address numerous issues in this area. As mentioned above, the implementation of projects aimed at addressing social determinants results in considerable improvement and reduced health inequality. Effective quality management programs are instrumental in achieving positive results and addressing the negative impact of such social determinants as education (Alcaraz et al., 2019). The inadequate access to healthcare services of people with low levels of education is associated with their insufficient income. People with no high-school education tend to have low-paid jobs, so health care services are often unaffordable for them. Limited resources also make people address medical staff when their health deteriorates substantially instead of having regular check-ups.
One of the areas to consider is the use of technological advances with a focus on information technologies. The implementation of projects encompassing the use of electronic medical records helps healthcare professionals to screen patients for the social determinants affecting their conditions (Hill-Briggs et al., 2020). Screening is the first step in helping patients to access resources available to them. It has been found that people are often unaware of opportunities they have, which prevents them from accessing quality care (Hill-Briggs et al., 2020). To ensure effective screening and informing, healthcare professionals should have the necessary skills to manage electronic medical records effectively. Hence, quality management programs at healthcare facilities can lead to direct effects and the improvement of health equity and positive patient outcomes.
Other quality management programs can be useful in addressing the social determinant under consideration as well. For instance, projects aimed at improving the work of interdisciplinary teams can bring positive results through the provision of high-quality care, shorter waiting time, fewer medical errors, and lower readmission rates (Hill-Briggs et al., 2020). By providing quality services, healthcare practitioners can attend to more patients, which will improve people’s access to care and make the problem of the personnel’s shortage, less burning. The use of technology is again beneficial in this respect as it helps to provide healthcare services more effectively. Advanced equipment and devices can help in diagnosing and treating various health conditions.
At that, one of the most far-reaching types of programs that have lifelong effects involves educating people (young populations) regarding healthy behaviors. Hill-Briggs et al. (2020) note that significant attention should be paid to mental health as low-income communities where people with low levels of education reside are vulnerable to such public health issues as alcoholism and other types of addiction. These populations tend to have unhealthy diets and insufficient physical activity. Therefore, numerous projects aimed at raising people’s awareness on the most relevant aspects are conducted. Medical staff, in collaboration with educators, informs people about the negative effects of unhealthy behaviors, ways to maintain healthy lifestyles, and steps to be undertaken to access quality care. Such projects are implemented in diverse settings, including clinical, educational, and community-based. Social support is an important component of such interventions and programs (Alcaraz et al., 2019). People are encouraged to shape their behavioral patterns, which is achieved through the involvement of families and community members.
Quality Improvement Project to Address Education with the Goals of Improving Health Equity and Patient Outcomes
It is possible to implement a quality improvement project addressing education to reach health equality and better patient outcomes. The program will involve such stakeholders as healthcare practitioners (mainly public nurses), educators, children and their parents, and communities. The initiative will encompass the provision of training to children and their parents within the educational setting, with several sessions held in the community. The project may be launched in a community characterized by the prevalence of a low-income population. After the evaluation of the outcomes, similar projects can be initiated on the state or even federal level. This incentive will be held based on public educational facilities to reach the most vulnerable populations.
The program will consist of regular educational sessions for children and their parents with lectures and workshops on a range of health-related topics. The areas to be addressed include a healthy lifestyle and diet, major health concerns, their negative effects, and associated risk factors, available resources to maintain an appropriate way of life. Public nurses will deliver lectures and run the workshops based on the mentioned domains. The program will be developed in close collaboration among healthcare professionals, educators, and community members. Educators will help in creating workshops and running the training sessions.
Community members may provide resources for the implementation of the project (spaces for community-based sessions, materials, investment). Local non-profit organizations aiming at improving public health or addressing specific health issues will be the most engaged actors as far as the community is concerned. Community members and companies can donate to increase the number of nurses in local public hospitals. They can also become advocates, who will address policymakers to allocate more funds to medical schools to invest in scholarships in similar initiatives. To be effective advocates, they will need certain training, so the educational sessions will involve workshops for building the necessary skills.
Conclusion
To sum up, it is necessary to note that education is one of the social determinants of health that have multiple lifelong effects. People with lower levels of education tend to be at a higher risk of the development of chronic diseases and higher mortality rates. People with a low-level education are likely to have lower income and limited access to health care. They are also less likely to maintain a healthy lifestyle and keep to a proper diet due to the lack of resources. Hence, education is one of the areas to be addressed to reduce health disparity and improve health equity in the United States.
Numerous projects and initiatives have been implemented on different levels. Some projects entail the provision of healthcare services within the contexts of educational facilities (this is specifically common when it comes to mental health). Physical activity is another aspect that has received significant attention, and numerous projects encompass encouraging students (and their parents) to be more physically active. At that, the major focus is on educating people to make them aware of health risks and ways to improve their health.
The proposed initiative includes the three areas mentioned above, which can be instrumental in reaching the highest results related to reducing health disparity and improving health equity. The project will be implemented in a local community, but after detailed analysis and evaluation, it can be expanded to other areas or even become a national program. It is also important to continue improving the existing projects aimed at addressing such social determinants of health as education by conducting further research. It is important to explore the ways this social determinant is associated with people’s gender, age, and cultural peculiarities, as well as other specifics. Education should stop being a challenge as it can be an opportunity for helping people and communities choose healthier options and focus on prevention rather than treatment.
References
Alcaraz, K. I., Wiedt, T. L., Daniels, E. C., Yabroff, K. R., Guerra, C. E., & Wender, R. C. (2019). Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy. A Cancer Journal for Clinicians, 70(1), 31-46.
Alderwick, H., & Gottlieb, L. M. (2019). Meanings and misunderstandings: A social determinants of health lexicon for health care systems. The Milbank Quarterly, 97(2), 407-419.
Coughlin, S. S. (2019). Social determinants of breast cancer risk, stage, and survival. Breast Cancer Research and Treatment, 177(3), 537-548. Web.
Harrington, R. A., Califf, R. M., Balamurugan, A., Brown, N., Benjamin, R. M., Braund, W. E., Hipp, J., Konig, M., Sanchez, E., & Joynt Maddox, K. E. (2020). Call to action: Rural health: A presidential advisory from the American Heart Association and American Stroke Association. Circulation, 141(10), e615-e644.
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Thornton, P. L, & Haire-Joshu, D. (2020). Social determinants of health and diabetes: A scientific review. Diabetes Care, 44(1), 258-279.
Medvedyuk, S., Ali, A., & Raphael, D. (2017). Ideology, obesity and the social determinants of health: A critical analysis of the obesity and health relationship. Critical Public Health, 28(5), 573-585. Web.
Raghupathi, V., & Raghupathi, W. (2020). The influence of education on health: An empirical assessment of OECD countries for the period 1995–2015. Archives Of Public Health, 78(1), 1-18.
Singh, G. K., Daus, G. P., Allender, M., Ramey, C. T., Martin, E. K., Perry, C., De Los Reyes, A. A., & Vedamuthu, P. (2017). Social determinants of health in the United States: Addressing major health inequality trends for the nation, 1935-2016. International Journal of MCH and AIDS (IJMA), 6(2), 139-164.