How Your Level of Education Predicts Your Level of Health
A notable epidemiologist explains how the relationship between education and health is a Catch-22 that sets back marginalized communities.
It should come as no surprise that the same marginalized communities who face a lack of health resources also face a lack of educational opportunities. They are dealt with double inequities that is difficult for them and their generations to overcome. That’s why Dr. Abdul El-Sayed has dedicated his life’s work to educating others on health issues as a spectrum involving many societal factors.
As a physician, epidemiologist, public health director, author, professor at Columbia University, and podcast host for the award-winning show America Dissected, Dr. El-Sayed offers a comprehensive perspective to some of the biggest challenges leading to early and preventable illnesses in America. He shared his thoughts on the crossroads of health and education with interviewer Darin Lim Yankowitz, Teach For America’s senior vice president of recruitment, at a TFA Equity Talks installment, a virtual event series bringing together leaders across many intersectional issues.
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“So much of what goes wrong has less to do with the bad decisions that cells make in our bodies and a lot more to do with the bad decisions that society makes. ”
To Lead Change, Go Back to the Root of the Problem
I'd love for you to bring us into your personal story. Please bring us into how you landed on medicine, public health policy, and how you incorporate your experiences and your identities along the way.
What tends to get read in a bio are these outward accomplishments or achievements and I find those to be less of an explanation of who I try to be every day than really a simple thing, which is the grandson to my grandmother.
The ninth of 14. Born in 1940s Egypt. The wisest, most intelligent person I've yet to meet in my life. But she never got to go to school. She was illiterate, raised in a time and a place where they didn't care to educate her, despite her obvious brilliance.
I would spend a lot of my summers in Egypt. In the 10 hours, often 15 hours with a stopover, I would travel about 10 years' difference in life expectancy. But what made it even more poignant, and this is something that I couldn't have understood, is that I didn't have to go across an ocean to Egypt. I had to simply cross a city line from where I grew up, down into the city of Detroit, and I can travel the same 10 year life expectancy gap in just 15 minutes.
My teta, she had eight kids but two of them died before the age of one. For me it was a sin asking whose babies get to live in whose babies don't? What is it about the way that we build a society that gives certain people access to things and other people non-access?
That really has been what I've tried to build my career around. I thought I wanted to be a doctor and I went to medical school, but I later realized that so much of what goes wrong has less to do with the bad decisions that cells make in our bodies and a lot more to do with the bad decisions that society makes. And so I really focused my work in public health and public policy trying to address those issues.
“When we think about health, we recognize that the single biggest predictor of people's health outcomes is their education.”
Delving Into a Continuous Loop of Hardship
You are the true expert. I'd love to ask you to bring us into an overview of how you see these two systems, education and health care, interacting with one another.
At a baseline level, if you can't breathe when you wake up in the morning because you have persistent asthma that's pulling you out of the rest of your life simply so that you can grab the next breath, it becomes an anathema to even think about your ability to go and engage in education. You can't do it.
There is no baseline education without health. At the same time when we think about health, we recognize that the single biggest predictor of people's health outcomes is their education. So the ability to read, I mean, this was fundamental to my grandmother's experiences. She couldn't read, right? She had her first kids in her teenage years and raised six of them while lost two of them. The inability to read leaves you without a basic resource that you need to be able to navigate and make health decisions in your life. That's what allows for a longer lasting arc of health.
Rather than asking if it is a classic chicken or egg problem—is it more health? or is it more education?—it's asking, how do you infuse the interplay of those things? And how do we build a society that allows for the mutual necessity of both of those things to be self-reinforcing? And self-rewarding?
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Joining Efforts to Create Change
How have you seen these types of systems barriers show up in your work in marginalized communities, in particular, and what's your view on what we need to be doing to try and remove those barriers?
We found, for example, in Detroit, upwards of 30 percent of our kids who would test positive for vision deficits would come back testing positive again next year. So you can have the most brilliant teacher, in the best-resourced class, but if the kid can't see what's on the blackboard it does not matter what's happening on the blackboard. Vice versa.
We say if you follow up with your primary care physician, then we can get your diabetes under control. But that requires a mental model of diabetes. That implies a certain understanding of the physiology underlying this disease. If you were robbed of a high quality education from the jump, that model may not be there for you.
The lack of health takes away the opportunity for education, which takes away health. As people who want to address the problem, we have to appreciate that there is no silver bullet, and you cannot tackle one without the other.
Discovering Many Ways to Make a Difference
You mentioned that you found this career wanting to address these stark inequities. You've had such varied academic and work experiences. Can you tell us a little bit more about the work that you're doing and how you see it leading to the system changes?
One of the things I came to appreciate early in my career was that you had to decouple what you wanted to change from how you wanted to change it. I think we do a pretty grave injustice to young people when we ask them, What do you want to be when you grow up? I think that tends to frame a life or a career around a particular position. That's not really consistent with the way that most of us come to what it is that we end up spending our lives doing.
I think decoupling means asking two questions: What do you want to change? and What gives you joy and meaning?
The two really big things that give me joy and meaning are getting the opportunity to work with other people, helping them unlock their skills and put them in positions to do work that they really value. That's the essence of what leading means. On the other, I really enjoy shaping ideas and being able to express those ideas in ways that unlock a story.
I've tried to decouple that from what I want to change, which is health inequity in the world. And that, to me, has always been clear. But here's the thing, right? When I was young, it was like, What do you want to be? And I said, I guess I want to be a doctor. Because that's how you fix these problems. But I came to appreciate that that's one way, sure, it is a really important way. But it's not the only way.
There are so many other ways to take on the challenges. And I had to ask myself, what do I really love doing? I enjoyed clinical work enough. But when I really thought about it, what do I feel like I'm best at and that I really enjoyed the most, it came to this sort of narrative work and this leadership work. I've tried to bring those things together with the work that I do, and I think, you know, for early career folks thinking about that, I hope that's a helpful model.
Leaning Into This Generation for a Better Future
As a parent and leader, Dr. El-Sayed says he has nothing but hope for a future world that is better than the one he grew up in. He is energized by the efforts of today’s generation who realize real change is more than acknowledging a problem and voicing words of inspiration. It means taking action, one step at a time, one person at a time, to drive a transformation that better meets the needs of all our people.