Health and Skills: Making the Connection

Adults with low literacy skills are four times more likely to report poor to fair health than adults with higher skills. This is two times the international average according to recent data from the Survey of Adult Skills (October, 2013), which is part of the Organization for Economic Cooperation and Development’s (OECD) Program for the International Assessment of Adult Competencies (PIAAC).

This correlation between skills and health presents great challenges to both the individual and his or her healthcare providers to communicate and address the prevention, management, and treatment of disease and healthy behaviors. Poor literacy, numeracy, and problem solving skills adversely affect health care, health information access, health outcomes, and appear to limit engagement in positive, preventative behaviors. At a time when the U.S. is spending more than $2 trillion a year on healthcare ($2.5 trillion in 2009, according to the Surgeon General’s National Prevention Strategy), even a fraction of improved outcomes could save millions of dollars. As a reference, the U.S. federal investment in the Adult Education and Family Literacy Act (AEFLA), which funds adult basic education and English proficiency classes, is $563 million.

U.S. adults ages 16-65 performed poorly on all measures of the Survey of Adult Skills, with average scores below international averages in literacy, numeracy, and problem solving in a technology-rich environment. While there are high performers in each domain, the U.S. population has a greater proportion of adults of working age with low skills (defined as below Level 2 on a five level scale) than the comparison countries (see more about the findings here).

The relationship between skills and health provides a strong case for investing in upskilling adults. The economic returns to skill development are clearly demonstrated in the Survey through the correlation of skills to higher wages, more permanent employment, and greater use of skills on the job.  The returns to improved health are likely to be at least as important. A healthier workforce is more productive with fewer days lost to illness. The healthcare costs of poor health literacy is demonstrated through higher costs for service, more emergency room visits, and fewer preventative services accessed.

There is a great opportunity to think about addressing skills and health simultaneously in a more holistic approach, as called for in the National Action Plan to Improve Health Literacy, issued by the U.S. Department of Health and Human Services in 2010. Embedding opportunities for skill development and practice in community health efforts is an underutilized approach. While contextualizing literacy in the context of health has been a promising practice, see resources at the LINCS Health Literacy Collection, too little has been done to use community-based health interventions as the anchor for literacy and numeracy interventions.

Community health workers – whether in hospitals, health centers, private primary care practices or as part of home health care or visiting nurse services – can help low-skilled adults apply the skills they do have to the immediate situation. Health professionals can use plain language and teach back methods of communication, and work closely with local educational service providers to make referrals more seamless and less stigmatized. Similarly, adult education workers can assist individuals with accessing health care, finding insurance, following treatment instructions, applying literacy and numeracy skills to everyday practices, and providing navigation assistance to services that can enhance healthy behavior. Services could be co-located for greater coordination and impact. Cross-training or shared training and professional development within a community could strengthen relationships and referral networks.

The Survey of Adult Skills (OECD, 2013) is clear that skills and quality of life issues are deeply interrelated, especially in the United States. The findings echo a recent report from the Institute of Medicine, U.S. Health in International Perspective: Shorter Lives, Poorer Health. Communities need to address these challenges as related, not separate issues, and find the means to take a holistic view of the quality of life issues faced by low-skilled, low-income, and low-English proficient populations when proposing solutions. Conducting a local health needs assessment and asset map of existing challenges, resources, and future growth projections can be a way to engage the community. Prevention and health safety campaigns are ideal opportunities to involve the full range of family-serving organizations in a community.

In November 2013, the U.S. Department of Education launched a national engagement effort to explore ways to increase our national capacity to improve the foundation skills of adults in the United States. Regional events have been held through the winter and communities are being asked to provide input and feedback from their own locally-hosted roundtable discussions to inform a national action plan.

In order to assist communities in hosting roundtable discussions, the Department created a set of resources and an online submission form. See www.TimetoReskill.org for the following tools:

  • Consultation Paper, a 10-page paper that can be shared in advance of an event to provide background on the skills issue and the framework for the national action plan.
  • Toolkit, a step-by-step guide to running a local roundtable from types of people to invite to the questions to pose.
  • Online feedback form for submitting feedback. (Please submit comments by March 14 to be considered in the Plan.)

We hope community health partners will be part of the solution! Consider hosting a roundtable discussion in your area and contributing to the national action plan.

Johan Uvin is the Deputy Assistant Secretary for Policy and Strategic Initiatives at the U.S. Department of Education, Office of Career, Technical, and Adult Education 

College-Bound Students Choose CTE Pathways in High School

Assistant Secretary Brenda Dann-Messier has her blood pressure measured by Cassandra Eddy, a student at Union County Vocational-Technical School in Scotch Plains, New Jersey  - credit Kathryn Forsyth, NJCCVTS

Assistant Secretary Brenda Dann-Messier has her blood pressure measured by Cassandra Eddy, a student at Union County Vocational-Technical School in Scotch Plains, New Jersey
- photo by Kathryn Forsyth, NJCCVTS

Rutgers University. Yale University. Northeastern University. Stevens University. University of Medicine and Dentistry of New Jersey. These are among the colleges that seniors from Union County Vocational-Technical Schools in Scotch Plains, New Jersey are headed this fall.

As one parent of a Yale-bound senior put it, “This is what high school should be for every student.” The Administration agrees, having issued both its blueprint for Perkins reauthorization in April 2012 and proposed a $300 million High School Redesign in the FY 2014 budget. Assistant Secretary for Vocational and Adult Education Brenda Dann-Messier states, “Our students shouldn’t have to make a decision between college or a career; every student needs to be prepared for both.” Union County Vocational-Technical Schools has turned this vision into a reality and, at the same time, become a school of first choice for students in Union County. Assistant Secretary Dann-Messier had the opportunity to experience the vision first-hand during her recent visit on May 23.

It used to be that enrollment in career and technical education, much less a full-time area career center, would not be the best option for students preparing for college, particularly at one of the leading universities in the nation. Union County Vocational-Technical Schools has fundamentally changed this situation and now makes enrollment in career and technical education the “sought-after option” for high school students.

Union County Vocational-Technical Schools offers five academy schools on its campus, including The Academy for Allied Health Sciences, The Academy for Information Technology, and a Magnet High School which focuses on STEM-related programs. Students participate in rigorous academic courses that are integrated with their career and technical education courses, complete work-based learning, earn college credit for courses taken during high school, and earn industry-recognized certificates.

School administration officials attribute their schools’ success to ongoing partnerships with business/industry and postsecondary education to develop and implement their programs. Students credit the teaching staff and career guidance counselors who help them acquire work-based learning opportunities, complete FASFA forms, and submit college applications. Parents recognize the entire school team for helping students gain the academic, career-related, and employability skills that help them prepare for their future.

Career Pathways in Construction and Healthcare Feed Employment Demand

The U.S. Department of Labor reported that the economy added 236,000 non-farm jobs in February, according to their preliminary figures.   Industries that added workers in Career and Technical Education pathways include Construction, Healthcare, Leisure and Hospitality, and the Motion Picture and Sound Recording Industries.

Industries with the most workers added to payrolls in the last month include:

  • +44,100   Admninistrative and Waste Services
  • +39,100   Health care and Social Assistance
  • +31,700   Specialty Trade Contractors
  • +23,700   Retail Trade
  • +20,800   Motion Picture and Sound Recording
  • +26,800   Professional and Technical Services
  • +20,600   Accomodations and Food Services

Industries with largest reductions in the number of workers in the last month include:

  • -31,700    Electronics and Appliance Stores
  • -14,700    Educational Services
  • -10,000    Government

Visit www.BLS.gov to see the press release, access employment figures by industry, and dig deeper into state and local data.

Employment figures based on preliminary data reported by BLS for February 2013.