October 12, 2008
By BILL FRIST, M.D.
As chairman of a global drive on children's health, I devote much of my energy these days to improving the survival odds for millions of children in the developing world.
It pains me to tell you that we have a lot of work to do to improve those odds for our own children here at home. And, counterintuitive though it may seem, I believe the place to start is with our education system.
A good education can help lay the foundation for a healthy life. A new report from a national commission describes large disparities in infant mortality in Tennessee and across the nation. The report by the Robert Wood Johnson Foundation Commission to Build a Healthier America, of which I'm a member, finds that babies born to mothers with less education are less likely to survive their first year of life than those born to more-educated mothers.
This gap in infant mortality by mother's education is larger in Tennessee than in any other state. Infant mortality rates are highest among babies born to mothers who did not graduate from high school — 11.7 deaths per 1,000 live births. For children born to mothers with a college degree or more, the rate is 4.9, a more than twofold difference.
Interestingly, this disparity is not merely a matter of extremes. Infants in the middle experienced shortfalls in survival, as well. For example, those whose mothers have some post-high school education have a death rate of 8.0 per 1,000 live births. In other words, we have a sliding scale of infant mortality that corresponds with maternal education. More years of education for mothers translate into better rates of survival for their children.
This pattern holds true across the nation. The commission has established a national benchmark of 3.2 deaths per 1,000 live births, the lowest infant-mortality rate seen in any state among babies born to mothers with 16 or more years of schooling. That's a rate we know is achievable — and the rate we must strive to achieve for all families.
But how to get there? First, we need to acknowledge that there is much more to good health than health care. In many ways, where and how people live, learn, work and play have more impact on their health than medical care.
As a doctor, I know firsthand that this is true. Poor health rarely occurs in a vacuum. It is shaped by many factors, including education and family income and the resources and opportunities they provide, like access to nutritious foods and adequate housing.
Take education, for example. Every child should have the opportunity to an excellent education. Poor education can lead to limited job options and lower income, which, in turn, can limit a family's chances to live in healthy homes and neighborhoods. That's a big part of why we have such a wide disparity in infant mortality rates in this country. If we addressed education and other social issues as part and parcel of health, we wouldn't have so much illness that required so much medical care, including an enormous amount of emergency care.
We spend more per capita on health care than any other country in the world, and yet our health is not nearly what it should be. Nor will it be, until we start focusing more on health than we do on illness. We need to pay more attention to what it means to be born healthy, grow up healthy and maintain good health as adults.
The fact that none of us is as healthy as we should be shows that all of us — employers, educators, public officials, religious leaders and others — need to come together and identify community-based solutions for improving health.
These solutions should be practical, affordable and grounded in evidence. They're out there, but we need to determine which ones will work best for our communities and put them into action. Providing opportunity is what we in the U.S. do best.
We need to give all children the opportunity to see their first birthday and develop into healthy adults. We need to mobilize our energy and our people here in Tennessee, and we need to do it now, before we write off the health of the next generation.