Understanding the Relationship between Educational
Attainment and Preventative
Healthcare Utilization in
Southeast Los Angeles:
Full-Length Research Paper

Background

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Despite reducing the risk of illnesses, diseases, and other health problems, preventative health care is heavily underutilized in the United States (4). A study in 2020 found that only 8% of Americans undergo routine preventative care screenings, such as blood pressure, diabetes, and cholesterol tests (5). Compared to other types of Americans, racial minorities such as Hispanic Americans are less likely to receive preventative health services due to socioeconomic disparities (6). The lack of preventative care usage among racial minorities can be partly attributed to their limited access to educational opportunities. An investigation conducted by Lee and Seon evaluated the relationship between educational attainment and health behaviors amongst young adult men of various ethnicities (7). The authors found that higher educational levels were positively associated with healthy food intake and preventative health visits such as routine eye exams and health check-ups. As a result of the above two positive associations, they concluded that education is a way through which health behaviors of the masses can be improved (7). A longitudinal analysis of Wisconsin high school graduates corroborates the trend of higher educated individuals being more likely to use preventative care services, concluding that college attendance was correlated with higher probability of preventative care use (8). In particular, college attendance was linked to an increase in the usage of flu shots, physical examinations, dental exams, and cholesterol tests. The research also indicates a causal relationship, rather than simply correlational, between increased college attendance and use of preventative care (8). Furthermore, an assessment of OECD countries from 1995 to 2015 found that well-educated adults are healthier than less-educated adults (9). Tertiary education teaches individuals the importance of preventative health practices, which is why we see that college attendees are healthier than non-college attendees as measured through indicators like infant mortality, life expectancy, child vaccination, and enrollment rates. Moreover, education has an overall impact of aiding individuals’ self-awareness of their own health status and increasing accessibility to healthcare (9). The relationship between educational attainment and preventative care use can be further contextualized by examining the COVID-19 pandemic. A recent investigation examined how educational status affected factors such as preventative behaviors and risk perception during the first year of the COVID-19 pandemic in Germany (10). The authors found that individuals with lower educational levels tend to underestimate health risks more compared to their more educated counterparts. This finding is particularly relevant because it explains why individuals with lower educational levels were significantly less likely to engage in preventative behaviors compared to individuals with higher educational levels. Overall, the study concludes that policies surrounding the COVID-19 pandemic must be explained in a way that accounts for varying engagement in preventative behaviors and risk perception due to educational disparities (10). A 2021 cross-sectional study across 3142 US counties assessed whether or not social factors played a role in COVID-19 vaccine uptake and hesitancy (11). A lack of high school education was a prevalent factor in communities with the lowest vaccination rates. The authors concluded that low education levels is a notable contributor to vaccine hesitancy. The reasoning is straightforward: the more knowledge people have about the vaccine and how it works, the less hesitant they become (11).

Overall, education improves the health status of individuals by producing long-term socio ecological benefits. On the individual level, it does so by enhancing cognitive skills, personality traits, and personal control, which are linked to health behaviors and therefore individual health. They also increase individuals’ economic resources, which improves socioeconomic status and thereby decreases probability of disease (12). A study conducted by Cutler and Lleras-Muney indicates that 30% of the relationship between education and health behaviors, also known as the education gradient, is explained by knowledge and various measures of cognitive ability. Using data from the National Health Interview Survey, various health behaviors’ mean rates were analyzed and compared across groups of different years of education (13). For example, an additional year of education correlates with a 3.0% lower probability of smoking, a 1.4% reduction in probability of being obese, a 1.8% reduction in probability of being a heavy drinker, and an increase in seat belt use by 3.3% from a baseline of 69%. All of these factors are extensively linked to health status (13). In this report from the field, the authors examine results from a survey conducted by the International Healthcare Organization (IHO) and review existing literature regarding the relationship between education levels and preventative care usage. Specifically, this study examines that within the population of Maywood and Bell, individuals with lower levels of education were associated with decreased use of preventative care services.

The International Healthcare Organization (IHO) is a 501 c(3) non-profit organization based in Los Angeles, California, composed of doctors, nurses, medical students, non-profit advisors, and healthcare administrators (3). IHO’s mission is to promote health equity and improve the overall health of underserved communities across the United States and around the globe. IHO began as an organization dedicated to direct service in the community through its sanctuary health clinics in the Southeast Los Angeles area. Over time, IHO grew its impact by expanding its provided services to communities across the United States and the globe. Through the implementation of unique healthcare safety-net systems, IHO enhanced patient care by providing immigrant, refugee, and homeless populations with comprehensive educational, medical, and mental health services.

Some of these innovative programs include the Telehealth Program, established in the COVID-19 pandemic to allow community members consistent healthcare access; the Prescription Medication Assistance Program, which offers IHO patients free prescription refills; and the Health Net Program, which provides free or reduced cost primary and specialty care services to residents of Los Angeles, focusing particularly on underserved populations. Additionally through IHO’s Complete Cognitive Care program, telehealth services are being provided to further increase access to psychiatric and behavioral care services.