adult education

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.

No Harm, No Foul

/ The Old Crank

(Updated Below)

Republicans in the House would like you to know that they haven’t really been hearing much about the sequester from their constituents.

From Roll Call this morning:

[W]hile the impacts are starting to appear in local media across the country, particularly near military bases, rank-and-file Republicans generally say they aren’t feeling much pressure yet, and they expect the sequester will simply stay in place.

“I think, generally speaking, people haven’t noticed,” said Rep. Tom Latham, R-Iowa, noting that the flap about canceled White House tours is one exception.

“I’m not hearing anything at home, really,” said Rep. John Campbell. The California Republican said he’s been asked about the sequester more by the press than constituents. He said he heard from one contractor who said, “You know, we may lose a contract over this, but we’ll survive.”

Campbell said Republicans going home for the Easter break are going to be focused instead on touting the GOP plan to balance the budget.

I’m not surprised that many House Republicans haven’t heard much from their constituents about the sequester. Republican members of the House (and only Republicans were interview for this story) often represent wealthier districts where, in fact, the sequester probably won’t have much of an impact.

But this does raise the question: During the upcoming House and Senate Easter recess (March 25th – April 5th), what will members (on either side of the aisle) hear about it? Do grassroots organizations have their folks prepared to meet with lawmakers during the break? Have folks back home just resigned themselves to the idea that the cuts are here to stay? Will stories that are “starting to appear” in the local media become more frequent?

There could be a lack of urgency about the sequester because many programs have not been affected yet. WIA Title II Adult education funding, for example, will not be cut until July 1st, because like many (but not all) education programs, it’s forward funded. So adult education programs aren’t going to see the effects until new grant awards are made over the summer. Plus, depending on how states decide to distribute the cut, I suppose some programs may not even see much of a decrease.

But it’s still important, I think, to speak up about the importance of federal support for adult education in our communities now, even if the sequester effects haven’t settled in yet. Remember also that sequestration is a multi-year process, and will work very differently next year. Instead of across-the-board cuts to every program, in 2014-2021 the cut will be in the form of overall budget caps. Congress and the administration will then have to figure out how to live within those reduced caps. In other words, after 2013, there are no automatic, proportional cuts to discretionary programs like adult education. It will be up to the President and Congress to decide how much to cut from each program. They could even eliminate funding altogether for some. (For those interested in the gory details, I recommend the Center for Budget and Policy Priorities latest paper on how this all works.)

I also continue to fear that over time, pressure on states to find money to shore up other places where the sequester is affecting their budgets is going to result in reduced state support for adult education, much in the way that California school districts have been snatching funds from adult education to support K-12. Which means that this is also an important time to let state lawmakers know how important adult education is in your community.

The media pays a lot of attention to the political wrangling between the administration and Congress over making some kind of deal to roll back the sequester, but without strong constituent pressure—and soon—I can’t figure out why we should expect that anything will actually be done.

Update: More on the same theme, from Brian Beutler at TPM:

It’s been nearly three weeks since President Obama issued the sequestration order. Across the country, newspapers carry reports of furloughs, airport closings, children kicked out of Head Start. The consequences are beginning to snowball. But lawmakers have reacted to the bad news with a collective shrug.

In the same week Congress is expected to pass government funding legislation that effectively locks in sequestration until the end of September, an unexpected reality is dawning on Washington: as bad as sequestration is, and was intended to be, it’s not bad enough to do what it was designed to do.

That’s left Democrats resigned to malfunctioning and underfunded government in perpetuity, and Republicans confident they can weather the coming months and turn sequestration spending levels into a new normal. (my emphasis)

Obama Administration: SKILLS Act Fails to Meet the Needs of Adults With “Literacy and English Language Needs”

/ The Old Crank

(Updated below)
STATEMENT OF ADMINISTRATION POLICYIn case you missed it, here is the Obama administration’s official response (known as a “Statement of Administration Policy”) to the SKILLS Act. The Republican-led bill to reauthorize the Workforce Investment Act recently passed in the House, but is likely dead-on-arrival in the Senate.

The administration says the SKILLS Act “would eliminate, or allow the consolidation of, many targeted programs, without providing the critical assistance needed by vulnerable populations,” including “adults with literacy and English language needs.” (my emphasis)

UPDATE: Acting Secretary of Labor Seth Harris also released a statement last week that was critical of the SKILLS Act. He doesn’t mention adult literacy specifically.