Adult Literacy

This Is the Way It Should Work Everywhere

/ The Old Crank

Education leaders in Biddeford, Maine have come up with a great idea (reported in the Biddeford-Saco-Old Orchard Beach Courier): let’s take our early childhood education leaders and put them in charge of adult education as well.

If the people accountable for early childhood education were also in charge of our adult education system, I think we’d start to see adult literacy more thoughtfully integrated into school readiness strategies, as well as a stronger push for adult literacy outcomes that are more closely tied to the role that parents and other caregivers play in the literacy development of their children. (And the evidence continues to build that this is one of the key strategies we should be taking to address early literacy development.)

There are, of course, many great family literacy program models that do the kinds of things described here, but what appears to be unique and encouraging about this is that it’s a district-wide strategy.

Study: Diabetes Patients Who Don’t Understand Basic Health Information Significantly Less Likely To Adhere To Prescribed Treatment

/ The Old Crank

Something new today to add to the list of health problems associated with low literacy: in a recent study conducted by the Kaiser Permanente Division of Research and the University of Washington School of Medicine, a big majority (72%) of the 1,366 study participants turned out to have limited health literacy and significantly poorer adherence to newly prescribed antidepressants compared to other patients.

According to Kaiser Permanente, depression occurs twice as frequently among adults with diabetes compared to adults without diabetes.

Although poor adherence to antidepressant medications has been a known issue with some diabetes patients, what’s new here is the evidence that diabetes patients with limited health literacy were much less likely to refill their antidepressant medications in a timely fashion than patients without such limitations.

Dr. Amy Bauer of the University of Washington School of Medicine, notes that “patients with limited health literacy may require more intensive counseling and clearer explanations about use of antidepressant medications and closer follow-up.” Considering the high number of participants in this study who were found to have low health literacy, I suspect that most doctors should, in fact, be prepared to deal with this issue.

But as a matter of public policy, we could also address this by working on improving the literacy skills of adults in this country to begin with, which would lessen the need for such interventions. Does anyone think it’s likely our health care system can really support the cost of more intensive counseling and closer followup what is likely millions of patients with low literacy/health literacy?

This study isn’t the first report to draw a connection between literacy/health literacy and public health (see link above). Shouldn’t improving adult literacy in the U.S. be a major component of our overall strategy to improve public health and lower health care costs in this country?

New Study Suggests Literacy Programs in Ghana Lead to Lower Rates of Infant Mortality

/ The Old Crank

Although it supports the (apparently) widely agreed notion among those in the global development community that adult literacy programs are not effective, a new study does point to an “unintended success” of such programs: decreasing child mortality.

So says Niels-Hugo Blunch, associate professor of economics at Washington and Lee University, in his recently published a paper, “Staying Alive: Adult Literacy Programs and Child Mortality in Rural Ghana.”

Blunch says that evaluations of adult literacy programs in developing countries tends to skip over beneficial outcomes that would cast them in a more successful light. From Washington and Lee’s news release:

Blunch explained that although the adult literacy program is formally about literacy and numeracy, it is really a multiplex program that integrates other modules such as health and social issues, income generation/occupational skills and civic awareness. Approximately 28 different topics are covered across those three modules.

Under the health module, women learn about family planning, teenage pregnancy, environmental hygiene, immunization, HIV/AIDS, safe motherhood and child care, drug abuse, traditional medicine and safe drinking water.

Blunch is hoping that publication of his paper will get the attention of the global development community, including the World Bank, and result in increased attention and funding for these programs, especially in rural areas.

I also thought this was interesting:

Classes in rural Ghana are held two to three times a week for a total of about six hours per week and, in most cases, there are 20 to 30 participants per instructor. It takes about 21 months to complete the course. Yet, according to Blunch, a significant reason for the skepticism and resulting reduction in funding of these programs is the poor outcomes in Latin America and South America, where classes frequently lasted only six to eight months, were shorter, and often also not with the additional health, income generating activities and civic awareness components.

I don’t have any direct experience with adult literacy programs outside of the U.S., so I can’t speak with any kind of expertise about them, but in general, with adult literacy, it shouldn’t be a surprise that programs that are longer, with a greater intensity of instruction and an integrated learning approach would lead to better outcomes than the programs he is describing in Latin and South America.

Blunch’s paper also included a cost-benefit analysis (again, this is according to Washington and Lee’s news release—I don’t have a link to the paper itself) of program participation that showed “substantial positive net benefits in monetary terms, including the future earnings of children whose deaths have been averted, even when disregarding women learning about income-generating activities, as well as the many other positive potential outcomes of program participation.”

From the perspective of domestic adult literacy policy and advocacy, I think it’s equally important to conduct this kind of research, and to point out these “indirect” outcomes to policymakers—and in monetary terms. (I know, of course, that there has been research like this, but there needs to be more of it, and it needs to be better publicized.) Anyone who has been around an adult education program here in the U.S. has seen the positive impact that simply enrolling and participating in a program can have on the individuals who have enrolled—in terms of their health and overall well-being, the example they set for their children, etc. We sell our programs short here in the U.S. as well.

Do Nonprofit Advocates Put Too Much Emphasis on the Charitable Deduction?

/ The Old Crank

I was planning to return to the charitable tax deduction issue again at some point—specifically, I wanted to delve again into the the tendency of several high-profile, Washington-based nonprofit umbrella groups to focus more on protecting the charitable deduction than advocating against budget cuts or for new revenue. But Patrick Lester, writing for the Nonprofit Quarterly, has already done a better job with this topic than I would have:

This narrow focus on the charitable deduction drew criticism from some in the nonprofit community, including Aaron Dorfman at NCRP. “Policies that incentivize charitable giving are important,” he wrote, “but nonprofits should be far more concerned about several other elements of the fiscal cliff negotiations. Our number one priority should be to raise tax rates on the wealthy by allowing the Bush tax cuts to expire for Americans earning more than $250,000 per year. We should also seek to prevent cuts to vital programs that serve poor and elderly Americans and to secure strategic investments that stimulate the economy and create jobs.”

Dorfman is right. According to the National Center for Charitable Statistics, public charities that filed annual 990 forms with the IRS in 2010 derived about a third (32.2 percent) of their revenue from government sources, including grants and fees for service from government sources, such as Medicare and Medicaid. By comparison, these same charities drew 13.3 percent of their funding from private contributions. (my emphasis)

Lester also cites a 2010 Urban Institute study of human service nonprofits that found an even higher level of dependence on public funding among these groups—about 65% of total revenues.

Lester writes: “It is clear from these numbers that large swaths of the nonprofit sector are substantially dependent upon government funding.” He goes on to ask why so many mainstream nonprofit organizations have not been advocating on the broader set of federal budget issues, particularly cuts to services for the poor, and offers some interesting explanations. If you are at all interested in this issue, be sure to read the whole piece.