Population Health Blog

Population Health Blog

Why It Matters

What does education have to do with health?

By Dennis Archambault

Education is one of the critical determinants of health, but often the least understood. Neighborhoods Taking Action Partnership, an program developed by the Detroit Community-Academic Urban Research Center, asserts that “a good education can lay the foundation for a healthy life.”

Those who are education may not analyze how their knowledge, and the privilege that knowledge may help them achieve, contributes to their health status. It may not assure that they will use that knowledge wisely, but they should “know better.”

The interrelationship between educational attainment — and presumed knowledge — and health is defined by lower incidence of heart disease, diabetes, self-reported poor health, and number of sick days among the well-educated. “The impact of education on health goes beyond what people learn in the classroom because health is impacted by every corner of a person’s life,” according to a fact sheet published by the Partnership in 2014. “People with more education are more likely to live in safer neighborhoods where they have access to healthy foods, good schools and green space for exercise; to be employed in a well-paying job; and to have strong relationships, all of which impact how well and how long people live.”

Consider a couple of these relationships:

  • People with more education are more likely to live in safer neighborhoods: This obviously implies less risk of physical assault and reduced stress from the fear of personal or property crime. It also is likely to mean that the neighborhood is likely to be closer to resources like quality food sources and health services. And the neighborhood is likely to have a better natural environment.
  • Green space for exercise: Just living next to a park or having greenways for walking, running, or cycling doesn’t mean that a person will exercise, but they’re more likely to do so than those living in a poorly maintained neighborhood where they’re frightened to go out alone. Also, an educated person is more likely to have had some physical fitness as a student, perhaps developing athletic discipline and a knowledge of the relationship between exercise and health.
  • Employed in a well-paying job: By definition, a well-paying job is more likely to offer a better health insurance benefit, as well as other benefits that contribute to well-being, such as sick days, or perhaps a health club benefit. Certainly, having more income allows greater access to good food, exercise facility options, and health services. And when you have to pay deductibles and co-pays for health services, you’re able to.

The Partnership makes one final, important point: “Education teaches us how to be healthy… Education increases knowledge and skills. The more education, the more likely people will be able to seek out and understand health information.” The challenge of health literacy is one that crosses all social strata, but impacts the functionally illiterate greatly. If you can’t read a pharmaceutical prescription, and can’t understand basic health concepts, you will have difficulty navigating the health system and maintaining health.

Neighborhoods taking action is funded through the Robert Wood Jonson Foundation’s Roadmaps to Health Community Grants Program, with matching funds provided by The Skillman Foundation and a grant from the W.K. Kellogg Foundation. For more information, contact the Detroit Community-Academic Urban Research Center at 734-764-5171.

Dennis Archambault is director of Public Affairs for Authority Health (formerly known as Detroit Wayne County Health Authority).


Health systems explore population health territory, from within their markets

By Dennis Archambault

The term “population health” is being defined somewhat differently in health industry circles, than among public health professionals: similar purpose, perhaps, but a  more exclusive connotation.

On May 7, Modern Healthcare magazine is hosting a panel discussion on population health for health care industry executives, “Population Healthcare Management: Strategies That Work.” The twist is in “population healthcare management.” The program features Joe Mullany, CEO of the Detroit Medical Center; Dr. Bruce Muma, chief medical officer of the Henry Ford Health System; and Dr. Thomas L. Simmer, senior vice president and chief medical officer of Blue Cross Blue Shield of Michigan.

According to event publicity, the program will “discuss how population health management is being addressed within the local healthcare market.” While here they say “population health,” they most likely mean managing the health status of patients within the service population of health systems. The program topics include:

  • Engaging patients in their care
  • Leveraging new technological tools and analytics to pinpoint issues and improve care
  • Participating in ACOs and other emerging delivery models
  • Managing the health of complex patients
  • Collaborating with insurers
  • Using population health management strategies to prevent re-admissions.

The program apparently will not discuss the role of health systems in “population health,” as interpreted by public health professionals. However, they are playing a role, which is emerging as an opportunity area within the community health needs assessment.

The Detroit Wayne County Health Collaborative is an initiative that has grown out of the data and community health needs assessment workgroups of the Health Authority’s Population Health Council. Led by David Goldbaum, the Health Authority’s executive in residence, the initiative brings representatives of health systems who are implementing their institutions community health needs assessments and related action plans and public health officials together to talk about creating a common approach to the assessment process and a collaboration around action plans.

This process is historic in that health systems, despite their community benefit programs and charity care, have tended to focus on their markets, not on vulnerable populations in the regions where they are located — which is one of the reasons why the health status of Wayne County is so low on the County Health Rankings scale, where some of the region’s top health systems are located.


Although some health systems may view the community health needs assessment in the context of the requirements of the law, enforced by the Internal Revenue Service, it should be seen as the historic opportunity that it is — where public and private interests can truly collaborate around the common goal of improving health status.

Dennis Archambault is director of Public Affairs for the Detroit Wayne County Health Authority.



APA Stress Survey: Income inequality fuels stress, compromises population health

By Esperanza Cantu

In early February, the American Psychological Association released results of a survey www.apa.org/news/press/releases/2015/02/money-stress.aspx indicating that financial stress weighed heavily on Americans nationwide. Many of us can relate to feeling stressed about money, but that stress can impact us more depending upon where we fall in society. The survey results indicated that financial concerns caused people to visit the doctor less, and disrupted their personal support systems as a source of conflict in relationships. This is troubling because we know that stress serves as a risk factor for the development of heart disease, diabetes, weight gain, anxiety, depression, and more.

A wealth of research links the relationship between low socioeconomic status (SES) and poor health, yet the causal pathway remains unclear. We know that living in poor communities can lead to poor life longevity, but recent evidence from the University of Wisconsin Population Health Institute continues to support that living in communities with high income inequality can be bad for health. Robert Sapolsky, a Stanford University professor of biology and neurology, delved into the relationship between income inequality and health in his guide to stress “Why Zebras Don’t Get Ulcers.”

Sapolsky postulates that in the health and SES gradient established by Michael Marmot and the Whitehall studies, perhaps it may not be about “being poor,” but perhaps “feeling poor.” Citing work by Nancy Adler of University of California at San Francisco, he writes that feeling poor in our socioeconomic world predicts poor health. (It certainly can be stressful to live around those much wealthier than us, and chronic stress is bad for health.) Parallel with this thought, Robert Wilkinson and others have shown that poverty amid plenty results in worse health and mortality rates.

Population health can be impacted by income inequality and “feeling poor” in a variety of ways, but a pathway proposed by Ichiro Kawachi of Harvard University points to social capital after controlling for absolute income. In a society with more social capital, we would find more trust, reciprocity, and participation in organizations for common good, and less hostility and hierarchy. To put this in context, wealthier people may have the ability to buy themselves out of social services, potentially leading to less investment in public-sponsored goods like education and public health, which we know promote life longevity. Furthermore, income inequality consistently predicts crime better than poverty, suggesting that income inequality may significantly impact health and other socioeconomic factors more than we previously thought.

Where do we go from here? Raising the income of one family will not make a huge difference as that would be a violation of the ecological fallacy—we cannot make conclusions about individuals due to trends of population-level research. Instead, to combat the ill effects of income inequality and financial distress on our health, we must continue to improve our community living conditions and social cohesion. We need to continue making systemic improvements in public transit, neighborhood safety, school quality, access to water and health care, and more. To care for our families and friends in times of financial distress, we can simply be a caring and accepting support system. The APA study reported that those with access to emotional support from family and friends experienced lower levels of stress than those who do not, and that can certainly be good for our health.

Esperanza Cantu is the W.K. Kellogg Population Health Fellow for 2015-16.