A Can of Worms. Is Education Health?

Over the past several years, we have seen education become more and more tied to partisan politics, as school and university funding as well as class curriculums have become the subject of political debate. Numerous studies have described the relationship between education and health; individuals who receive a more complete and holistic education are not only better able to provide for themselves while living in better communities and practicing healthy behaviors, but they also perform better academically and do better when responding to injury. (1)

I have decided to split this conversation into two: what has happened in North Carolina, and more broadly what impact do these policies have on health.

This journal article was inspired by a piece I read in “The Daily Tar Heel”, the University of North Carolina’s student-run newspaper, written for both UNC students as well as Chapel Hill and Carrboro residents. The article titled “'A slap in the face': Gov. Cooper declares a state of emergency for public education,” focuses on North Carolina Democratic Governor Roy Cooper’s statement on May 22, 2023 regarding the state’s public education system. (2)

So what happened preceding this speech?

The North Carolina Senate and House of Representatives turned their attention to public education early in 2023. Why is this the case? Well, it seems that during the COVID pandemic, enrollment in North Carolina public schools dropped significantly. (3) In fact, between the 2019-20 and 2021-22 school years, roughly 34,000 students dropped out of North Carolina public schools. However, private and homeschool enrollment increases during this time period totaled only 22,000 students, resulting in approximately 12 thousand students being “unaccounted for,” or removed from the education system entirely. The North Carolina education system has the 5th highest number of unaccounted-for students when looking at all state education systems in the US. The reasoning behind these statistics is even more worrisome. Many North Carolina communities lack affordable housing, mental health resources, jobs, and other resources that are prerequisites for students who wish to receive a complete education. In response, some counties (such as Wake County, NC) are allocating more money to find unaccounted-for students and hire more counselors to reduce drop-out rates.

New legislation in the pipeline including House Bill 823 (HBill) and Senate Bill 406 (SBill) will further change the public education system for better or worse in North Carolina. These bills are part of the Choose Your School, Choose Your Future plan focused around increasing access to education, although partly at the cost of the state public education system. SB406 was passed by the Senate on May 18 and included $13.2 million to fund public education in the coming years, which is actually a decrease in funding year-on-year. This decrease is especially important regarding teacher pay. Governor Cooper finds that North Carolina ranks 32nd nationally in teacher pay and 46th in “beginner teacher” pay. (6) Additionally, neighboring states have passed North Carolina in teacher funding and as a result, teachers have begun leaving the state creating a shortage. While Governor Cooper has suggested an 18% teacher pay raise over 2 years, SB406 includes a teacher pay raise of only $250 over 2 years. While this decision may push more teachers out of the state, the Senate and House have included special provisions for private schools, furthering the shift from public to private education in the state.

SB406 includes scholarship funding for students to attend North Carolina private schools, increasing the accessibility and affordability of these schools. (7) Distributed by the NC State Education Assistance Authority (NCSEAA), these funds were provided to roughly 25,500 students in the 2022-23 school year. SB406 increases the availability of funds to students, removing both the income requirement and the clause stating that the student receiving the funds must have previously attended a public school. While Governor Cooper may be right in that North Carolina’s public education system is in dire need of repair, the House and Senate seem more focused than ever on improving the private school system. The new question thus becomes: who is truly affected by this lack of public school investment? Additionally, is there any way that we can bring unaccounted-for students back into the private or public education system while maintaining the standards provided to current students?

What are the broader health implications of decreased access to education?

Education level directly affects health in a variety of ways. These “non-medical” factors that affect healthcare outcomes are called the “social determinants of health” (SDoH). Education specifically affects income, food security, housing, community safety, and transportation access. (8)

In terms of life expectancy, a PNAS research article finds that adults with a bachelor’s degree are more likely to live longer and stay healthier when compared to adults without a degree. (9) This is likely because education level is correlated with resource access (including income which affects housing availability and food security). Individuals with higher education levels also tend to be more informed about their health and know more about when to seek medical care in the case of injury or illness. (10) Thus, individuals with more education tend to have increased access to preventative and emergency care.

Education levels can also increase disparities between individuals and communities. Under-resourced schools which tend to be in lower income neighborhoods have increased levels of bullying and violence which may result in adverse childhood experiences (ACEs) among children. These ACEs may result in long-lasting psychological and physical damage, furthering the gap between children.

While it is important to increase access to education to improve community health, little data exists about the effects of shifting from public to private schools. The fact that many North Carolina families live in communities far from a private school, raises further questions about how underserved students will receive transportation to and from their chosen school. Ultimately, with more data in the coming 2023-24 school year, perhaps we can determine what the repercussions of the Choose Your School, Choose Your Future agenda are and revisit legislative solutions to potential problems, increasing equity and improving public health in North Carolina.