Higher Education, Health Outcomes & Rural America

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This article, which includes perspectives from leaders in health, education and economics, appeared Feb. 14 in the Chronicle of Higher Education. We thought it would be of interest to our Wildcat Parents.

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People who don’t go to college are getting sicker and dying younger. That’s the reality playing out in a region of southeastern Missouri known as the Bootheel, one of many poverty-stricken rural areas across the country where few residents have four-year degrees.

Research has shown that education makes a difference in terms of health outcomes: Get a college degree, and you’re more likely to lead a healthier and more prosperous life. Go without, and, for a number of reasons, you’re more likely to face a range of health problems.

So what can colleges actually do about it? We posed that question to several experts in health, education, and economics, as well as to some college leaders. Here’s what they said.

Devote Resources to Serving More Low-Income Students

Graduation mortar on top of booksThe gap in deaths and illness for Americans who attend college compared with adults who do not is large and growing. Although poor health has many causes, expanded access to education has been shown to improve both economic and health outcomes. For example, compulsory-schooling laws increased earnings and lowered mortality among affected students; tuition-reimbursement programs for Canadian veterans increased income by 15 percent for each additional year of schooling; and young mothers with easy access to community colleges experienced improved infant health, a lower chance of smoking during pregnancy, and increased use of prenatal care.

Those examples show how colleges can put education within reach for Americans who live in places like the Bootheel. But colleges can do more. Even high-achieving low-income students miss out on educational opportunities because they have little knowledge about how and where to apply to college, or what to expect once they get in. For $6 per student, the Expanding College Opportunities project, a randomized, controlled trial providing information and support to high-achieving low-income students, significantly increased the number of colleges to which students applied, the quality of those institutions, and the likelihood of admission.

As described by Grinnell College’s president, Raynard Kington, colleges can make admissions more “access aware” by giving students from low-income families a bump in admissions, just as they routinely do for children of alumni.

Colleges can devote resources and expand access to low-income students and students from less-educated communities. Once the students are admitted, colleges can help them navigate financial aid and curricular support to improve graduation rates.

Can we be certain that expanded access to education will stop towns from dying? No, just as medical interventions may fail to cure illness, so, too, could expanded access to education. But the side effects of expanding education include an increased set of skills, a network of classmates with similar interests and abilities, and an increased capacity to think critically, solve problems, and adapt to rapidly changing circumstances, like those that transformed the Bootheel.

Ellen Meara, professor, Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College

Stop Ignoring the Needs of Rural America

If nothing else, the result of the 2016 presidential election has finally placed the national spotlight on rural America. Rural people voted overwhelmingly for Donald Trump. Places like the Missouri Bootheel have been left behind by the declines in the farm economy, the collapse of manufacturing because of global competition, the chronic outmigration of young people and population aging, and persistent poverty. Indeed, the population of the Bootheel peaked at just over 131,000 in 1940 and since then has declined to half that number. Depopulation has become the demographic norm across rural America.

Unfortunately, rural people and places have been largely ignored or forgotten in today’s increasingly urban society. The public — and most politicians and the news media — have little if any real connection to rural people and their problems. This also is arguably the case for much of higher education.

America’s colleges and universities offer few courses on topics of rural social problems and little research on rural matters in the social sciences or humanities, or, for that matter, in business or law or medicine. Rural-infused curricula in higher education have been eliminated or relegated to backwater programs or majors. Departments of rural sociology or agricultural economics have been renamed to reflect changes in instructional priorities. Or, worse, they have been eliminated altogether or have experienced drastic budget reductions or big cuts in faculty size.

We can’t tackle rural social and economic issues without first understanding them and perhaps reflecting on our own rural biases. This reminder wasn’t always necessary. The traditional land-grant missions of many flagship state universities — the University of Wisconsin, Texas A&M University, the University of Missouri, Washington State University, and the University of Georgia, among many others — included embracing the goals of public engagement, service, and information outreach. Professors were rightly viewed as public servants of both taxpayers and students.

Agricultural-experiment stations conducted state and local applied research on the usual agriculture-related topics but also actively promoted the social sciences. Likewise, the Cooperative Extension Services on most land-grant campuses, including my own, Cornell University, were designed to extend scientific information and new knowledge to the countryside — to rural people and places — through university outreach and engagement.

If rural people today, in places like the Bootheel and elsewhere, don’t trust or value colleges or what they do, it’s because they often lack any real contact with college professors or professional staff members. Misinformation and social media have filled the void.

Colleges must re-establish themselves as sources of reliable information and expertise. Public engagement with rural communities and organizations — and their leaders — is essential. But this will require a rededication of attention and resources on traditional strengths at leading research and teaching institutions, in subject areas and the kinds of faculty viewed as important, in the courses taught, and in the public served.

—Daniel T. Lichter, professor and director of the Institute for the Social Sciences, Cornell University

Focus on Research-Based Strategies

Research and a magnifying glass“A Dying Town” is the kind of story that keeps a college president up at night. The challenges in rural Missouri are not unlike those facing rural America, but this unflinching look requires us to take stock of what we in higher education can do to help our citizens in places like Missouri’s Bootheel.

I am proud of the work our campuses in Columbia, Kansas City, Rolla, and St. Louis are doing, from preparing teachers for diverse classrooms to the extension programs that help Missourians benefit from our research in vital areas such as agriculture, nutrition, and entrepreneurship. To meet the critical need for access to rural health care, we started the Springfield Clinical Campus partnership to educate and train an additional 128 medical students to serve rural Missouri.

We must continue to connect with rural America and redouble our partnerships with other institutions and the state. We know that higher education confers many benefits, including a longer, healthier, and more financially secure life. As a university president, I have the privilege of meeting people every day who have benefited from the transformational power of higher education. That is something I want for all Missourians.

This fall, the University of Missouri at Columbia signed the Missouri Land Grant Compact, which guarantees that any student who qualifies for admission and is Pell Grant-eligible can attend the university tuition-free. This program is expected to provide access to thousands of students who otherwise could not afford college.

In The Chronicle’s sobering story, there were glimmers of hope — hope because of people like Freda Kershaw, who encourage Missourians to pursue higher education. She works for University of Missouri’s ParentLink program, which offers research-based strategies to engage families and reduce adverse childhood experiences.

This is work that every college can and should be doing. It’s our core principle as a land-grant university.

—Mun Y. Choi, president, University of Missouri system

Support Efforts to Improve Your Community’s Health

There are several efforts underway in southeast Missouri and at Southeast Missouri State University at Kennett to address the public-health crisis in this region.

Since opening, in 2000, the Kennett campus has provided higher-education opportunities to thousands of students in the Missouri Bootheel. A central theme there has been serving the public-health needs of the region by providing both credit and noncredit local education opportunities for Bootheel residents, and by supporting and collaborating in community-health initiatives.

This spring the Kennett campus will offer a Community Health Worker Program to train front-line workers who live in and understand the communities in which they serve. This high-quality, intensive program will provide employment and advancement opportunities in health-related organizations to an essential group of workers. Increasing the number of trained community-health workers improves access to care for hard-to-reach populations and strengthens efforts to promote health and prevent disease in rural, underserved communities.

In the meantime, Southeast Missouri State continues to serve the medical needs of the rural Bootheel population through its mobile health center, Southeast Health On Wheels, known as the S.H.O.W. Mobile. This 38-foot, handicapped-accessible vehicle provides medical and dental services to Southeast Missouri communities where access to care is especially difficult.

The S.H.O.W. Mobile visits three to four schools weekly on a monthly rotation during the school year. Fifty to 70 schoolchildren are provided dental care each month. The proportion of residents below the poverty level in the six-county area is above 20 percent, so the need for dental care is significant, since many dentists do not accept Medicaid as payment. The schools allow their students to visit the S.H.O.W. Mobile for their dental needs without their being counted absent.

Southeast Missouri State has a longstanding tradition of offering a number of complete bachelor’s degrees to train professional educators and social-service workers who wish to earn a degree and put their skills to work in this underserved area of the Bootheel. Our Kennett campus and our students pursuing higher education there are proof of what can be accomplished when we work together for the good of the community and its residents.

—Carlos Vargas, president, Southeast Missouri State University

tree of diversityRecognize Racial Disparities in Health Outcomes

When considering the role that education can play in addressing the public-health crisis in places like Missouri’s Bootheel, it is important to acknowledge that the health returns to higher education are not equal for all individuals. Consider the difference in remaining life expectancy at age 25 between those with less than a high-school degree and those with a college degree or more. For white women, the college graduate can expect to live roughly nine years longer than the high-school dropout. But for black women, this college-degree advantage is reduced to roughly five years.

There are many reasons that the health benefits of education may be unequal across race and ethnicity, including differences in the quality of institutions that individuals attend; the noncognitive skills necessary to overcome barriers to achievement; exposure to discrimination; and feelings of social isolation. Our recent research may help resolve one piece of this puzzle. [The high-profile research that The Chronicle’s reporting focused on examined skyrocketing mortality rates among white, middle-aged Americans.]

We find that the physical health returns on college completion are not uniformly beneficial for young adults in the United States. They vary by early-life socioeconomic status and race and ethnicity. White college graduates are healthier, on average, than their less-educated peers, regardless of whether they grew up in advantaged or disadvantaged environments. However, for black and Hispanic young adults from severely disadvantaged backgrounds, college completion is not associated with improved health, and may actually exact a health cost.

Our research suggests that college completion alone may not improve health outcomes. Colleges must attend to the barriers and stressors that first-generation minority students face in completing their degrees, and must develop programs to foster social support and feelings of belonging to help all individuals translate their advanced degrees into better health.

—Lauren Gaydosh, postdoctoral scholar at the Carolina Population Center, and Kathleen Mullan Harris, professor of sociology, both at the University of North Carolina at Chapel Hill

Acknowledge How Your Practices Contribute to Inequality

Colleges must engage with their communities to identify how their practices contribute to social and health inequities, and to ameliorate them. Here are some strategies.

They should establish trusting, respectful relationships with people and agencies around them, to build a foundation for broader actions. That means listening, setting goals and following through on them, and managing conflicts along the way.

Colleges should support and participate in early-childhood programs that focus on literacy and math as well as behavioral development. And they should expand their offerings to meet the needs of diverse communities. By creating structures to address the financial, academic, and social challenges that students face before, during, and after college, colleges can be catalysts for social change.

—Keon L. Gilbert, associate professor of behavioral science and health education, and Elizabeth Baker, professor of behavioral science and health education, both at Saint Louis University

Emphasize Retention and Meeting Employers’ Needs

Colleges and universities have a vital role to play in improving the economic prospects and health of local residents. “College-promise” programs, which create a tuition-free path to a certificate or degree for local residents, can increase educational attainment and reduce behaviors that may negatively influence health. But such programs should be open to older adults as well as recent high-school graduates, and colleges need to use strategies that increase student retention and completion, especially among nontraditional and older students.

Even more critically, colleges need to work with local businesses and community organizations to ensure that their students have the skills demanded by local employers, so that degrees or certificates earned by residents lead to decent jobs. It is often said that a good job is the best antipoverty program. It may be the best public-health program, too.

—Brad Hershbein, economist, W.E. Upjohn Institute for Employment Research, and Michelle Miller-Adams, professor of political science, Grand Valley State University

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