Published in The News Tribune, February 27, 2013.
Each year as a nation, we spend more than $150 billion on research to find health-improving products. Such research has led to spectacular advancements in the health of those born prematurely or afflicted with heart disease, diabetes or cancer.
Yet when it comes to promoting a healthy population, we shouldn’t be so quick to congratulate ourselves.
It is true that public and private investments have dramatically improved the quality and length of life. But we’ve also invested far too little on measures to prevent health problems. The United States has the highest rate of preterm births and one of the highest rates of diabetes in the industrialized world.
In short, our health care system is terrific at solving the health problems that it and we fail to prevent.
What’s true of health care is also true of social policy. Pick your social problem, and you’ll find that we make significant public investments after problems emerge, but fail to make the smart ones necessary to avoid them.
On any given day, at considerable public expense, two million Americans are imprisoned. As a share of the population, we lock up five to 10 times more citizens than do our peer countries. We also have the largest number of high school dropouts and unemployable citizens.
One reason for our inability to make sensible investments to prevent social problems is a missing profit motive. Someone can make a profit off products that promise better health. But no one can make a profit off a social program, even if that program improves health, reduces crime, increases graduation rates or decreases unemployment.
A second reason is that social programs have no counterpart to the gold standard of medical research, the clinical trial. Efforts to evaluate a social program are nearly all marred by thorny methodological problems and then sidetracked by ever-ready critics.
These challenges are illustrated by the uphill battle faced by President Barack Obama as he presses the case for public investments in pre-school.
It’s very difficult to prove that investments in early childhood education pay off. Studies that show a positive return tend to involve a small number of children; critics argue that what’s true for a few does not hold for the nation.
More to the point, whatever the data might say, it is tough to convince people that the odds of someone winding up in prison or becoming a teenage single mom can be traced to those malleable preschool years.
But there is indeed substantial evidence that among low-income children, a quality education at ages 3 and 4 has long-lasting effects. Kids who attend high-quality preschools typically start school ready and able to learn to read and do math. Low income 8-year olds who do not read at grade level are several times more likely to drop out of high school than are those who do. No one doubts how costly this problem is.
So convincing are the gains from early childhood education for at-risk children that if it were a matter of a medical innovation rather than a social policy, entrepreneurs would be beating down the door to invest in it. Instead, we’re way behind other countries in making high-quality preschool affordable for those children who need it most.
Fortunately, Obama’s initiative to expand early childhood education is a terrific one. And at $10 billion, it’s also affordable. If successfully implemented, it will easily pay its way in the future. Yet the key to any federal plan’s success will be to make sure the funds are concentrated and not diluted.
For low-income children at risk, low-quality, “low-dosage” early childhood programs rarely work. This means that a successful program can’t skimp on hours, teacher pay and qualifications – or on expectations.
Moreover, the best programs are comprehensive ones that combine a high-quality school with home visits to support and connect families with the services that ensure their children thrive at home as well as in school.
The good news is that Obama’s initiative entails all of these features: it’s very ambitious. But if we expect it to prevent some of our challenging social problems, it must be.