Want to Improve U.S. Health? Invest in Pre-K

Every year, the United States accounts for fully half of all the money spent globally on medical care. We spend 2-1/2 times more per person on health care than most developed nations. Yet, we are far less well – and we’re getting sicker. In 1980, the U.S. ranked 15 among affluent countries in life expectancy at birth. By 2009, we had slipped to 27. It’s time to rethink our priorities when it comes to investing in health.

What we don’t need to do is spend even more money on medical care. Access to quality care, while important, is only one small part of the formula for achieving a long and healthy life. Far more determinant are a broad range of social and economic factors -- a nurturing childhood; a healthy diet; opportunities for exercise; freedom from violence, crime, and drug abuse; and a quality education.

I believe these social determinants are just as much a “vital sign” of health as blood pressure and cholesterol levels. That was also the conclusion of the Robert Wood Johnson Foundation (RWJF) Commission to Build a Healthier America, an independent, non-partisan group of 16 academic and medical leaders that reconvened last year. On January 13, the Commission issued a report identifying a series of actions that can improve the health of all Americans, with a particular focus on early childhood education.

You may well ask what pre-K has to do with health. The fact is, there is a direct link between the two. Numerous studies have shown that exposure to significant adversity in early childhood, such as chronic poverty, violence, and neglect, leads to a greater risk of lifelong chronic health conditions in adulthood. On average, 25-year-old college graduates can expect to live nine years longer than their counterparts who have not completed high school.

This education/health connection has only grown stronger in today’s knowledge economy. Since the 1990s, life expectancy has fallen for people without a high school education, while completing more years of education improves access to well-paying jobs, health insurance, medical care, and the resources to live a healthier lifestyle.

To prevent children from growing into unhealthy adults, the Commission recommended that the U.S. guarantee access to high-quality early childhood development programs for all low-income children under age five by 2025. That may sound costly, but the return on investment would be substantial. The Commission estimated that early childhood development programs for at-risk families return $3 to $17 for every dollar invested. Another rigorous analysis by Nobel Laureate James Heckman found that each dollar spent educating a four-year-old yields an annual lifetime “return to society” of 7 to 10 percent.

Minnesota has taken that message to heart. In 2008 it started offering early childhood education scholarships of up to $5000 to children from poor families. A 2012 study of the program estimated that high-quality pre-K programs will yield a six-fold return on investment by reducing public spending on social and educational services, lowering rates of crime and teenage pregnancy, and reducing welfare dependency.

Early childhood education is so clearly beneficial that fifteen governors, from states rural and urban, red and blue, included new funding for early childhood education in their budgets last year. Oklahoma is one of the earliest adopters; a Republican governor initiated the state’s universal pre-K program in 1998. Today, 74 percent of all four year olds are enrolled, one of the highest rates in the country. On the other side of the country, New York Democratic Gov. Andrew Cuomo just proposed a budget of $1.5 billion over five years to provide universal pre-K throughout the state.

Even in a divided Washington, politicians agree on the benefits of early education. Earlier this month the House approved a bipartisan spending bill that allocated $1 billion, a 13 percent increase, to expand the Head Start early education program. President Obama may go even further in his State of the Union address on January 28 -- he is expected to propose free, universal preschool for all of the nation’s four-year-olds. As Harvard School of Public Health Professor David Williams, the Commission’s staff director, said in a PBS Newshour interview, “I think there is a lot of interest in pre-K education across the political spectrum in the United States now because the evidence is so strong that there is such a tremendous benefit for our society.”

For more insight into the benefits of early childhood education, I invite you to watch the video below, created by the Virginia Commonwealth University Center on Society and Health with support from RWJF. And I would love to hear from others about innovative projects aimed at creating a healthier America, where well-being is determined by far more than how much medical care we consume.

Please join a panel of distinguished guests convened by RWJF on Friday, February 7, for a Google+ Hangout that will examine efforts to invest in the youngest Americans.

Risa Lavizzo-Mourey, MD, MBA, is president and CEO of the Robert Wood Johnson Foundation, the nation’s largest health philanthropy.