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Money, Power, and Resources: The Struggle for Health and Education Justice

Wesley Epplin
July 30, 2014
This year marks the 60th anniversary of the landmark Brown v. Board of Education decision, providing an important opportunity to take stock of the status of public education in the United States, the progress we’ve made, and the enduring challenges we face.  

Health and Medicine Policy Research Group (Health & Medicine) recognizes the vital importance of education and educational attainment to improved health status and outcomes.  Joining education professionals in calling for guaranteed access to high-quality, equitable education fits squarely within our mission of promoting social justice and challenging inequities in health and health care.

To engage local health and education professionals on this topic, Health & Medicine will host a forum, the first of its kind in Chicago, entitled Education and Health Equity: Everybody In, Nobody Out, on August 14, 2014, examining the intersection of health and education.  This forum represents a unique opportunity to examine the reciprocal relationship between these two areas: just as education is closely linked to health status, people’s health, well-being, and socioeconomic position are linked to their ability to further their education.  

This event comes at a critical moment for public education in our country and in our state. Recent research has documented that in 2008, “US adult men and women with fewer than twelve years of education had life expectancies not much better than those of all adults in the 1950s and 1960s.”1  The Centers for Disease Control and Prevention (CDC) have prioritized both education and the social determinants of health within its Healthy People 2020 objectives.  One of the overarching goals in this national health agenda is achieving health equity, eliminating disparities, and improving the health of all groups.2 Yet, as the Robert Wood Johnson Foundation points out, “the United States is the only industrialized nation where young people are less likely than members of their parents’ generation to graduate from high school.” 3

Education in Illinois
These facts are playing out in a particularly dangerous way in Illinois.  According to the Center for Tax and Budget Accountability, despite having the 15th highest per capita income among the States, Illinois ranks 40th in the US in per-capita education spending (based on data from the National Association of State Budget Officers).  Illinois funds public K-12 education below even the recommendations of the State’s own Education Funding Advisory Board. 4

Since 2001, Chicago Public Schools (CPS) has closed, “phased-out”, “turned around”, and consolidated 159 schools, drawing the ire of impacted students, teachers, community members, and advocates (more on that below).   Furthermore, CPS’ closure of 49 elementary schools and one high school in May 2013 further threatens Chicagoans with the problems of inequitable access to high-quality education and concomitant unfairly distributed socioeconomic and health status and outcomes.

Further reductions in state funding for school and other vital public services are likely as Illinois is scheduled for its current flat income tax of 5% to recede to 3.75% in January of 2015.  Legislative efforts for a fair tax in Illinois could provide needed revenue to adequately fund education, public health, Medicaid, public safety, and infrastructure, all of which contribute to the public’s health.

At this juncture, we must ask ourselves, what role can and should health professionals play in promoting health through advancing equitable educational access? Crucial as safe routes to school policies, healthy vending, school lunch, physical education, sex education, nursing, and counseling are to health, so is advocacy for the fundamental human right of all children to access high-quality education.

When large numbers of schools are being closed, what are the community health impacts?  How can public health practitioners support the communities, schools, families, children, and educators whose objections have often gone unheeded? These questions deserve answers, and, as the decisions impact community health, a response from those tasked with improving public health—informed by impacted communities, educators, and history—to the divestment from and dismantling of public education infrastructure, is warranted. 

Education as a Social Determinant of Health
The Centers for Disease Control and Prevention (CDC) uses the following definition for the social determinants of health, which is from the World Health Organizations (WHO) Commission on the Social Determinants of Health, and may be a useful frame for considering equitable, high-quality education as a contributor to health equity:

Social Determinants of Health: The complex, integrated, and overlapping social structures and economic systems that are responsible for most health inequities. These social structures and economic systems include the social environment, physical environment, health services, and structural and societal factors. Social determinants of health are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world [emphasis mine].  



For institutions and individuals that have explicitly expressed the importance of making progress on the social determinants of health, a given structure, system, or policy should be judged by the degree to which it promotes or hinders a more equitable distribution of money, power, and resources. The World Health Organization’s (WHO) A Conceptual Framework for the Action on the Social Determinants of Health: Discussion Paper 2 places a strong emphasis on strategies to address context, intersectoral action, social participation, and empowerment. 8

This WHO paper also states:

In this context, human rights embody a demand on the part of the oppressed and marginalized communities for the expression of their collective social power.  The central role of power in the understanding of social pathways and mechanisms means that tackling the social determinants of health inequities is a political process that engages both the agency of disadvantaged communities and the responsibility of the state.

With this framing, we must reconsider the assumptions that underpin our education policy and ask: Is the agency of disadvantaged communities being honored and are the relevant government agencies acting responsibly vis-à-vis public education?  How can our society provide an equitable, high-quality education—a human right—to all students?  Are decision makers paying adequate attention to the vociferous objections and protest from impacted communities against the agenda driving many changes in public education?  

Education “Reform” and Public Outcry
A major, national education “reform” agenda has emphasized a neoliberal approach to our education system. This agenda has led to advocacy for and implementation of significant modifications including increased funding competition among schools through the Federal No Child Left Behind and Race to the Top initiatives, using high-stakes testing to rank schools, and deeming some schools to be “failing” and then “turning around” or closing them. We’ve also witnessed the opening of privately operated—but publicly funded—charter schools that beyond seeking “innovations,” have increasingly been used to privatize public schools.

Across the country, many teachers, students, and community members have countered these changes through negotiation, community meetings, formal complaints, protests, and strikes, such as the Chicago Teacher’s Union 2012 strike, which received national attention.  The ideas and rationales for these changes are discussed and strongly refuted in The Journey for Justice Alliance’s  Death by a Thousand Cuts: Racism, School Closures, and Public School Sabotage.13  

What have been some of the complaints regarding this neoliberal education agenda’s impact on people’s control of education within their own communities, on community health, and on racial justice?  Considering the social determinants of health framework briefly outlined above, what impacts on distributions of money, power, and resources have been observed and can be expected?

The Death by a Thousand Cuts report states:

… All of these changes have been implemented despite widespread and passionate opposition from the affected communities. Time and time again, the extraordinary wealth and power behind these policies have been used to override the will of our communities; to bully our communities into accepting these changes.  Why our communities? Largely because it was perceived that we lacked the political power to withstand such bullying, and that there would be limited public outcry over such dramatic changes within low-income communities of color [emphasis mine].13

On May 13, three civil rights complaints were sent to the Department of Education’s Office of Civil Rights and the Justice Department, challenging that closures in Chicago, Newark, and New Orleans disproportionately impact African American students.

The Chicago complaint, filed by the Advancement Project and accompanied by a letter from the Journey For Justice Alliance and Chicago’s Kenwood Oakland Community Organization, as well as other organizations, stated:

Schools that serve students of color have been the primary target of CPS school actions – of all affected schools between 2001 and 2013, three out of every four of those schools were intensely segregated African-American schools, and 89 percent were of schools serving 98 percent students of color or higher.5

Underscoring the charge of racial discrimination, it also stated:

Even if CPS’s use of school closings, phase-outs, turnarounds, and consolidations is not tantamount to intentional discrimination, CPS is still prohibited from engaging in policies or practices that have the effect of discriminating by race. CPS’s school closure practices cannot survive this disparate impact analysis.5

What about negative impacts on the health and wellbeing of communities? 

The Death by a Thousand Cuts report states:

Closing a school is one of the most traumatic things that can happen to a community; it strikes at the very core of community culture, history, and identity, and… produces far-reaching repercussions that negatively affect every aspect of community life. It has been nothing short of devastating to the health and development of many of our children and youth, has put a strain on our families, has contributed to the destabilization and deterioration of our communities, has undermined many good schools and effective school improvement efforts, has destroyed relationships with quality educators, and has contributed to increased community violence.13

These and countless other objections regarding school closings speak to the very distributions of money, power, and resources emphasized as paramount within the social determinants of health.  For those concerned with achieving health equity—again, an overarching goal set forth within the CDC’s national public health agenda, Healthy People 2020—ensuring that every child has access to an equitable, high-quality education must be on the agenda for health equity.

Intersectoral Collaboration
In order to advance education and health equity, further intersectoral collaboration is needed among health professionals and those working on the ground within our schools, including educators, social workers, counselors, nurses, parents, and students.  Thus far, there have been limited opportunities for these sectors to move beyond their silos regarding the school reforms outlined above, share their knowledge and perspectives, and to chart a course for change. The August 14, 2014 Education and Health Equity: Everybody In, Nobody Out forum will provide one such opportunity.

This forum will include keynote addresses from both Karen Lewis, President of the Chicago Teacher’s Union, and Linda Rae Murray, Chief Medical Officer for the Cook County Department of Public Health (and Health & Medicine Board Member). Several other speakers will address funding, the historical and current policy context related to education, health inequities in Chicago, and perspectives from people who live and work in some of the schools and communities impacted by the dysfunctional education context discussed herein.

Health & Medicine’s Founder and Chairman, Dr. Quentin Young, coined the maxim, “Everybody in, nobody out,” with regard to universal access to high-quality, equitable, and culturally competent healthcare.  We believe that this phrase can be applied to education as well: the health of communities and the wellbeing of our broader society are dependent upon universally accessible, equitable educational opportunity.

Valuing social justice necessitates actions that devalue instances of social injustice. To that end, health professionals can learn from and support the common cause of justice that is shared with educators.  When schools are being defunded and closed down in spite of communities, those of us who are discontented by the current inequitable distribution of money, power, and resources in our society must actively seek opportunities to advocate that community needs become central to education policy and to engage in other such actions for justice.

Registration is open for Health & Medicine’s forum Education and Health Equity: Everybody In, Nobody Out, coming up on August 14!

References:
1 Olshansky, S.J., Antonucci,T., Berkman, L., Binstock, R.H. Boersh-Supan, A.,Cacioppo, J.T. Carnes, B.A., Carstensen, L.L., Fried, L.P., Goldaman, D.P., Jackson, J., Kohli, M., Rother, J., Zheng, Y., and Rowe, J. (2012). Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Affairs, 31 (8) 1803--1813
2 Healthy People 2020.  Centers for Disease Control and Prevention (CDC).  U.S. Department of Health and Human Services (HHS). Online. http://www.healthypeople.gov/2020/default.aspx
3 Why Does Education Matter So Much to Health?  Health Policy Snapshot.  Robert Wood Johnson Foundation. March 2013.  Online. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2012/rwjf403347
4 The Illinois State Budget and Tax Primer. Center for Tax and Budget Accountability.  March 2013.  Online. http://www.ctbaonline.org/sites/default/files/reports/ctba.limeredstaging.com/node/add/repository-report/1384883277/R_2013.03_FINAL_FY2013%20CTBA%20IL%20Budget%20and%20Tax%20Primer.pdf
5 Re: Complaint against Chicago Public Schools Under Title IV and Title VI of the Civil Rights Act of 1964. Journey for Justice Alliance.  May 13, 2014. Online. http://b.3cdn.net/advancement/05d51d8dad82f1f1cd_lh1m6sitf.pdf
6 Social Determinants of Health Definitions.  CDC, HHS.  Undated.  Online. http://www.cdc.gov/socialdeterminants/Definitions.html
7 Education and Health.  Issue Brief #5: Exploring the Social Determinants of Health.  Robert Wood Johnson Foundation. April 2011.  Online.  http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf70447
8 Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva, World Health Organization, 2010.  Online. http://www.who.int/social_determinants/corner/SDHDP2.pdf
9 Nancy Krieger. Epidemiology and The People’s Health: Theory and Context. New York: Oxford University Press, 2011.
10 Why Education Matters to Health: Exploring the Causes.  Virginia Commonwealth University Center on Society and Health.  Robert Wood Johnson Foundation. Online. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf412692
11 Lisa F. Berkman, Ichiro Kawachi, and M. Maria Glymour. Social Epidemiology, Second Edition. 2014. Oxford.
12 Journey for Justice Alliance is an alliance of 36 grassroots community, youth, and parent-led organizations in 21 cities across the country. 
13 Death By A Thousand Cuts: Racism, School Closures, and Public School Sabotage.  Journey For Justice Alliance.  May 2014.  Online. http://www.j4jalliance.com/wp-content/uploads/2014/02/J4JReport-final_05_12_14.pdf