Reading at grade level by third grade: A social determinant of health?

The relationship between health and education is well-documented; however, public health limits its engagement with the education sector to activities related to interventions that contribute directly to population health measures such as immunizations and more recently healthier food choices on school grounds.  In public health, evidence is the impetus for action; however, waiting for the development of an evidence base that clearly illustrates causal pathways to better health outcomes may not be feasible or even necessary in the case of education.

Educators have been aware of the importance of reading in the early grades to academic achievement for at least twenty years. However, there is little knowledge of below-grade level reading as a root cause of poor academic performance and low levels of high school graduation in the public health community.  In some instances, there may be resistance to engage in advocacy activities related to grade level literacy because they may compete with obesity prevention initiatives. 

  Advocating to  maintain funding for reading intervention programs, summer reading activities, and community based interventions that promote/encourage reading does not require the degree of constituency building associated with the adoption of healthy food policies and practices in school districts.  Teachers are a natural, effective, and well-organized constituency as are elected officials, business, and public safety. 

A broad coalition, including the nation's leading foundations, launched a campaign to draw attention to the fact that nearly two thirds of the nation's fourth graders read below grade level.  This has significant implications for health literacy, health disparities, and the success of health reform.   Local  health departments can build on existing relationships with schools and address what may be a  fundamental root cause or contributing factor to poor health/health disparities.  Public health's recent foray into cross-sectoral collaboration in some sectors is viewed as yet another interest group demanding a change in policy or practice.  This is not likely to be the case if public health supports and demonstrates the potential benefit of funding community-based reading interventions.  Teachers, administrators, & school boards do not need a tutorial on the co-benefits of higher reading scores to education and public health.

A report released by the Annie E. Casey Foundation, Double Jeopardy: How Third Grade Reading Skills & Poverty Influence High School Graduation, by Dr. Donald J. Hernandez may be a warning for public health.  It can be accessed at:

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