August 2020, Volume XXXIV, Number 5

Public Health

Education as health

A partnership that is changing lives

high school diploma or GED (General Educational Development) certificate is required for many jobs, and can boost future earning potential—with incomes rising even higher for those who attend college. Individuals who have completed their education also experience lower rates of preventable conditions and better overall health. One Minnesota health plan is partnering with a national organization to pave the way on all of these fronts for its Medicaid and MinnesotaCare patients.

Covering education as a health benefit

UCare, a nonprofit, community-based health plan serving nearly 300,000 Medicaid and MinnesotaCare members, now works with GEDWorks—the official turnkey education benefit program from the creators of the GED—under a pilot project to serve its members in 18 counties.

The program helps members in select counties improve their employment prospects by paying for their GED-related training, support, and exams. It was an untested concept at the time of development, but the program has already helped participants jumpstart their careers, life aspirations, and financial security—and may result in better health outcomes for them and their families.

Local disparities

While Minnesota often ranks high in quality-of-life measures, it has some of the worst disparities in the nation when it comes to education and health. Only 82% of Minnesota students earn a high school diploma within four years; this number is significantly lower for students of color and for immigrant populations. Eighty-seven percent of the state’s White (non-Hispanic) students finish high school on time, followed by Asian students (84%), Hispanic students (65%), Black students (65%), and American Indian students (53%).

Minnesota ranks 34th out of 50 for overall high school graduation rates.

When compared with other states, Minnesota ranks 34th out of 50 for overall high school graduation rates, according to data from the U.S. Department of Education. The rankings differ by demographics: the state ranks 32nd for White students, 45th for Native Americans, 46th for Asian Americans, 48th for Black students, and 50th for Hispanic students.

High school incompletion perpetuates the cycle of poverty for these students. According to state data, having a high school diploma or GED increases earning power by 37.5%—a nearly $10,000 per year median wage increase. Education clearly has the power to help lift people out of poverty.

Education and health

How does poor education affect health? According to the American Public Health Association, adults who do not complete high school have poorer health and are more likely to die prematurely from preventable conditions such as cardiovascular disease, diabetes, and lung disease.

Other outcomes for those with different educational histories:

Employment. Among Minnesotans 16 years and older, those with less than a high school diploma have unemployment rates of 13.1%. That rate is 3.1% for those with a bachelor’s degree. (Note: these figures predate the COVID-19 pandemic).

Diabetes. Adults 18 years and older without high school diplomas or GEDs have diabetes rates of 11.1%, compared to 5.4% for those with college degrees.

Prenatal care. Births without first-trimester prenatal care numbered 29% among mothers with a high school diploma or less. For those with more than 12 years of education, the rate was 13.6%.

Smoking. Among those without a high school diploma or GED, smoking rates were 34.6%. Just 7.1% of college graduates smoke.

The 2017 Minnesota Statewide Health Assessment stated: “Education is one of the clearest and strongest predictors of lifelong health. When we have more education, we are more likely to live longer, healthier lives. Success in school leads to higher earnings, and this improves our living conditions. Education allows us to find better-paying jobs, with healthier working conditions and benefits including health insurance and paid leave.”

Children of educated parents are more likely to be healthy, too. Parents who are educated on the value of prevention are more likely to protect their health and that of their children by scheduling recommended checkups, screenings, and immunizations.

Mental health can also benefit from education. In a recent blog post, Vicki Greene, president of the GED Testing Service, refers to a study that found young people who drop out of high school are more likely to be depressed than high school graduates in their early adult years. “Adults with higher levels of education often have better people skills, are afforded more advantages, and tend to have better coping mechanisms—all of which lead to better mental health,” she wrote.

Health literacy

The U.S. Department of Health and Human Services (HHS) defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.” It comes as no surprise that people with lower education levels struggle more to understand health terms, prescription instructions, and treatment plans. In more than one national study, low health literacy was directly related to poorer health and lower educational status.

Individuals with higher educational attainment also tend to use health care resources more appropriately and efficiently—knowing when to see a primary care doctor, use telehealth, visit urgent care, or go to the emergency room. Finally, improved health literacy may empower people to be more proactive about their health and that of their families … and to embrace healthier lifestyles.

GEDWorks: advocacy and support

A high school degree or GED is required for most jobs. Many of us take this level of education for granted, but, as discussed previously, the number of Minnesotans dropping out of high school is surprisingly high. Within UCare’s state public insurance programs, there are members who grew up with the odds stacked against them in impoverished circumstances—where education is difficult to pursue, life is about survival, or families struggle with mental health or substance use disorders.

The UCare–GEDWorks partnership helps these members reverse the course of their lives with an extra level of support, advocacy, and encouragement, and to change the trajectory of their lives through education. The program equips graduates with the skills and knowledge they need to excel both inside and outside the classroom. Many of those who have obtained their GEDs through GEDworks have continued their education, with more than 50% attending college programs. These graduates also go on to pursue successful careers.

Members are matched with a bilingual advisor, online study materials in English and Spanish based on assessment test results, connections to local adult education programs, practice tests, and free GED tests—all paid for by the health plan to provide a second chance at a high school diploma.

Adults who do not complete high school have poorer health.

Since UCare launched the program in a limited number of Minnesota counties in 2019, there have been nine graduates, with a tenth on track to take the test soon. More than 100 members are enrolled and studying. The program started in four rural counties and has since expanded to 18 counties across the state, including Dakota, Ramsey, and St. Louis counties. The pilot program is capped at 200 members. Member impact will be evaluated for continuation or further expansion. UCare plans to expand the program to Minnesota communities where assessments show the greatest need and benefit to our members. We also will continue to expand member engagement in the 18 counties where the program is currently available.

Success stories

UCare’s first member graduate, Lydia from Blue Earth County, earned her credential in 2019 after years of wanting to do so but lacking the finances to pay for it. Lydia’s mental health issues in high school caused her to leave before graduation. Through GEDWorks, she was able to take practice tests and work closely with a personal advisor. Within a month, she took the four GED tests and passed. Upon earning her GED, she applied and was accepted to a local university, where she’ll start this fall.

Irene from Montgomery, Minnesota, dropped out of school after eighth grade to work. She had immigrated to Texas from Mexico at age 12, and later moved to Minnesota to join relatives and take a job with Seneca Foods. For years the 45-year-old mother of four would attempt to study for her GED, but found it too hard to stick with it. When she received the email from UCare inviting her to try the free program, she jumped at the chance. Irene aced her practice test and passed her four tests in just two weeks. She appreciated the emotional support from her advisor at every step along the way. Irene will be applying for new positions at Seneca Foods for which she now qualifies. The best part—the pride her children have in her accomplishment.

For UCare member Christopher, earning his GED was a personal goal. He had wanted to do so for many years, but the cost of preparation and testing were barriers. His previous education was inconsistent, after changing schools several times because of persistent bullying. Christopher successfully completed high school, but his school lost track of his transcript, so he had no proof of graduation, which led to missed job opportunities. After studying hard and completing all four GED tests, Christopher now feels a deep sense of pride and confidence. “It’s a major personal accomplishment which I celebrated with my family,” he said.

Our most recent graduate, Vanida, sums up her surprise and appreciation for the program. She was aware that some companies offer GED support to their employees but said, “I think that it’s awesome to know you have some sort of medical assistance, and that they still support you in getting your GED.”

Other participants offered similar praise for the health-plan sponsored program, which allowed them to pursue a GED without financial barriers, the support of advisors, the resulting career opportunities, and the simplicity of the program itself.

Building for success

We recommend that primary care doctors encourage patients to complete their GED at any age. Some employers—for example, in the fast-food industry—sponsor free training, support, and tests for their employees. Community education programs often offer affordable GED workshops and training. Patients who earn their GED will not only benefit from higher education and career opportunities. They will be empowered to better understand and take charge of their health and that of their families.

Bruce Cantor, MD, MS, is a medical director at UCare, a nonprofit, community-based Minnesota health plan that offers Medicare, Medicaid, and individual and family coverage. Dr. Cantor earned his MD—and his master’s degree in Health Policy and Administration—from the University of Illinois at Urbana-Champaign. He is board-certified with the American Board of Internal Medicine and the American Board of Pediatrics. 

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Bruce Cantor, MD, MS, is a medical director at UCare, a nonprofit, community-based Minnesota health plan that offers Medicare, Medicaid, and individual and family coverage. Dr. Cantor earned his MD—and his master’s degree in Health Policy and Administration—from the University of Illinois at Urbana-Champaign. He is board-certified with the American Board of Internal Medicine and the American Board of Pediatrics.