Reducing Racial Health Disparities

There has been a lot of talk plus hundreds of millions in philanthropic dollars committed in recent years to address a range of racial disparities in the United States.   Very little of that talk and money have been committed to long-term investments in school health. And how much has all of that spending increased racial health equity?

We saw a dramatic improvement in health outcomes in low-income schools with racially diverse student bodies, when University of Arizona increased the quantity and quality of physical activity in 20 schools with 16,000 K-12 students:

Please see the Programs page for more details on how this was achieved.

This degree of rapid improvement in racial disparities – 4x in 3 years – is unheard of in other domains – whether in education, wages, housing, you name it.

For example, schools would love to achieve even a fraction of this degree of growth in reading and math proficiency.

What is more, in addition to improving child health, fitness in children bodes very well for future health in adulthood.

Also, clinicians could never expect to achieve this much improvement in health outcomes, unless they used a hyper-expensive “miracle drug” like Semaglutide—which would be unaffordable for most individuals—or for society. Tens of millions of people would need that drug for the rest of their lives at a cost of hundreds of billions of dollars annually.

The bottom line: To improve the health of blacks, Latinos, Native-Americans—indeed, of all Americans—in a major way—major accountable investments need to be made in schools.

Healthy Students Healthy States gets us there.

Decreasing Income Inequality with Better Health

So, does lack of health literally make you poorer? Unfortunately, …YES!

As chronic disease has surged in recent decades, the increase in out-of-pocket deductible spending limits for health insurance has far exceeded wage growth, while employee health insurance premiums have also increased faster than wages.

How can we reduce income inequality, when wages are not growing enough to make up for health cost inflation?

We also know, from the Milken Institute studies (and common sense), that increased absenteeism due to chronic disease reduces hours worked and therefore wages, especially for lower-income working-class hourly workers.

Many lower-income hourly workers qualify for “free” Medicaid public health insurance. Yet many, perhaps most, of those individuals and their families have a de facto “Catch-22” cap on their take-home pay. If their income goes up a lot, they lose access to free public insurance— and could end up on balance worse-off financially. That increase in salary may well not make up for having to start paying a private insurance premium PLUS much higher out-of-pocket costs for their health care (in large part because of their and/or other people’s chronic conditions, which are by far the largest driver of health costs).

If we are serious about increasing incomes and reducing income inequality, we must improve health habits and prevent chronic disease more effectively.

Another hard truth: In pursuit of a better life for lower-income families, we have focused on very expensive and hard things to change on a large scale—postsecondary education attainment, affordable housing, getting much higher-paying jobs…even “ending poverty”.

Time to prioritize something we can actually realistically accomplish at-scale and at a reasonable cost: improving child health through schools—in order to make a true permanent difference in incomes well into adulthood across an entire state.

Healthy Students Healthy States gets us there.

What About More Education?

Some say that more postsecondary education can help reduce income equality—with higher salaries for young people from lower-income families. Couldn’t many people make up for higher health care costs with higher education?

Then we ran those numbers. We were disappointed—but we weren’t entirely surprised:

It turns out that, when you subtract out the cost of college debt AND the lost wages from time spent in college courses—AND for people from lower-income families: the lower-than-average real-world salaries they typically receive after college—THEN also deduct the cost of employer-based health insurance benefits of those higher paying jobs—the remaining disposable income may often not even exceed a no-college-required lower wage job which qualifies someone for “free” Medicaid health coverage!