Less stress now, better outcomes later

Shocking news — reducing immediate stress allows people to improve their distant futures.

Adrianna MacIntyre at Vox passes along an interesting study concerning Medicaid expansion and educational attainment:

A 10 percentage point increase in childhood Medicaid eligibility reduced the rate of high school dropouts by 5 percent and increased completion of a bachelor’s degree by 3.3 to 3.7 percent.

Previous research has demonstrated a positive short-term relationship between access to health care and education — when schools offer health care services to students, attendance rates rise and teen pregnancies fall — but this paper is the first to look at educational impacts over a longer time frame.

 We’ve seen a lot of evidence on the economics and choice structures during scarcity that people are cognitively overloaded because there is no such thing as a good decision just a series of really nasty and ugly trade-offs that must be made to solve a current problem. 

This mindset brings two benefits. It concentrates the mind on pressing needs. It also gives people a keener sense of the value of a dollar, minute, calorie or smile. The lonely, it turns out, are better at deciphering expressions of emotion. Likewise, the poor have a better grasp of costs.

This scarcity mindset can also be debilitating. It shortens a person’s horizons and narrows his perspective, creating a dangerous tunnel vision. Anxiety also saps brainpower and willpower, reducing mental “bandwidth”, as the authors call it. Indian sugarcane farmers score worse on intelligence tests before the harvest (when they are short of cash) than after. Feeling poor lowers a person’s IQ by as much as a night without sleep. Anxieties about friendlessness have a similar effect. In one experiment a random group of people were told that their results on a personality test suggested a life of loneliness. This random subset subsequently performed worse on intelligence tests and found it harder to resist the chocolate-chip cookies provided for them.

We know that the people who were eligible for Medicaid expansions pre-PPACA tended to be from families that were either poor or sick.  Medicaid functions as an imperfect substitute for increased cash income as people both feel better/are healthier which is quite valuable in and of itself, and Medicaid replaces previous cash outlays for medical services.  Increased income or more accurately, an increased consumption budget that is tied to current resources without indebting the future usually means a better ability to plan for the future.  This is not rocket science — remove immediate stress and problems allows people to devote resources to their futures.

Share On Facebook
Share On Twitter
Share On Google Plus
Share On Pinterest
Share On Reddit

22 replies
  1. 1
    Davis X. Machina says:

    Problem is, you can build an entire political party on the people out there who figure “The best way to make my life better is to make my life better. The second-best way to make my life better is to leave mine unchanged, and make yours worse, out where I can see it”

  2. 2
    WereBear says:

    @Davis X. Machina: The second-best way to make my life better is to leave mine unchanged, and make yours worse, out where I can see it

    Gosh, yes. It’s some kind of primitive “magic” that messed up brains grab onto. “This guy might not have done it, but as long as someone goes to jail…”

    Stress is much on my mind right now… not only have I not yet gotten to my specialist appointment (still almost a MONTH away) but our driveway has been taken away for long term road construction. Groceries, laundry, and the like weren’t fun enough with the three flights of stairs. Now I add in parking a couple of blocks away, too.

    And did I mention that driveway rises two stories all by itself, from the street to the doorway? Oh the fun just never ends, does it?

  3. 3
    aimai says:

    I think its interesting to think about all the nickle and diming and test stress we subject poor schools and poor children to in the name of “improved scores” when its pretty obvious that free breakfast and lunch and on site medical care would, after school programs in the arts and more playground time during the day would probably pull kids scores up and increase graduation rates just as effectively. But there would be no payoff for the “pain caucus” and the testing business magnates so we can’t simply improve the environment for the kids and take anxiety out of the equation.

  4. 4
    RaflW says:

    I can remember, in my lifetime, a (all too brief) period of time when Republicans weren’t batshit crazy and would have viewed this study as a policy guide that confirms what they say they want: get people out of poverty and into working life and productive society.

    I’m sure we’ll now be told by our GOP that Medicaid is still an evil that saps initiative and leads to couch-bound thugs eating t-bones.

    Because why the fuck should facts matter when you have the holy tax cuts catechism – and the punishment for straying is electoral death.

  5. 5
    NonyNony says:

    @aimai:

    I think its interesting to think about all the nickle and diming and test stress we subject poor schools and poor children to in the name of “improved scores” when its pretty obvious that free breakfast and lunch and on site medical care would, after school programs in the arts and more playground time during the day would probably pull kids scores up and increase graduation rates just as effectively.

    If reformers were serious about improving the lot of poorly performing schools, they would press hard for the following:

    * Free breakfasts and lunches for all kids attending school
    * Free medical care for all kids while they are enrolled in school (or until they turn 19, I guess)
    * Free day care for kids too young to go to school, and free before and after school care for kids in school

    Do that – without means testing, just raise the goddamn taxes to pay for it for all kids – and performance would improve across the board.

    Funny how reformers push all sorts of expensive solutions but never think to push for the three things that would really help these kids perform better.

  6. 6
    another Holocene human says:

    That’s why our meritocracy betters, none of whom–Rhee, Gates–ever knew any kind of poverty have deemed it best to stress test urban teachers and darwinize urban school districts so that poor children, through hormesis, will grow robust and clever and ruthless to survive, a master race to guide us to a new American century. Or poor kids who already struggle will get fucked with testing regimes instead of learning and have all their enrichment programs cut but no worries they have uniforms and can be paraded around as the good kind of obedient proles for the cameras. No biggie, Gates grand kids will go to public schools in a hyper exclusive burb or one of those rural country private schools that doesn’t take vouchers or Switzerland or something. Plus their last name will have a Gates in it.

  7. 7
    WereBear says:

    @another Holocene human: And in another massive irony they never seem to get, they were not means tested this way.

    So many of our pundits (McMegan and Douchehat come to mind) had their road paved, signals turned green, and any flat tires changed while they stood there whining over a substandard latte.

    So we should ask them… just how do they know throwing children in to a pit and giving scholarships to those who emerge… how do they know this works?

  8. 8
    Kay says:

    @aimai:

    There’s a whole group around “community schools”. They don’t get nearly the press that the Michelle Rhee types get, but it started in Cincinnati in 2002. They went in a different direction with “reform”. They’re the most-improved urban district in Ohio. It takes a long time. There are no miracles.

    DeBlasio went down there when he was running for mayor, and Pittsburgh public schools just hosted them in Pennsylvania.

    I was smiling because the keynote speaker was Reverend Barber of Moral Mondays fame. He’s a big public ed supporter. It’s a… little different than the Bill Gates ed reform types! A little grittier. Less, shall we say, incredibly wealthy. Perhaps more practical :)

    It’s just not true that there is “no alternative” to the one flavor of ed reform, the test and punish approach. That one flavor dominates media and the places that try something else get absolutely no credit but there ARE alternatives.

  9. 9
    gene108 says:

    @RaflW:

    Even back then they were not totally on board with it or else expanding Medicaid to cover the working poor would have been a no brainer or turning Medicare into a national single payer health care system would have happened in the last 50 years.

    I think part of the problem is most politicians do not know anyone who is either working poor and cannot afford insurance or on Medicaid, but is scared to look for work because any income will cause them to lose Medicaid benefits.

    For them these people are just abstractions to be discussed like any other abstract concept.

  10. 10
    Kay says:

    @aimai:

    Here’s the NYTimes on the pilgrimage to Cincinnati.

    DeBlasio is going forward with it, or so he has announced.

    I have wondered about the Medicaid piece of this, long term benefit. So many of my clients children are now on Medicaid when they were uninsured before. I think the dental care alone will probably pay off big.

  11. 11
    MomSense says:

    @aimai:

    I can tell you as someone who taught arts for years that yes–more arts education combined with healthy meals for breakfast and lunch, on-site medical care and more counseling services would do wonders. The way we fund schools is the worst. It is also ridiculous how many teaching jobs are now Ed-tech jobs which is a way to not have to pay librarians and arts teachers for any time other than classroom time. If you spend 2-3 or more hours a week prepping for your classes or have to spend 2 hours every day attending special ed meetings or filling out the required forms (they tend to put a lot of special ed students in arts classes) you do not get paid for that time even though you are mandated to fulfill the requirements. You don’t get paid for grading, and often you have no funds for supplies or music or whatever. It really is a horrible feeling to want to do well for your students and not have what you need to make it work.

  12. 12
    Higgs Boson's Mate says:

    @RaflW:

    Republicans have relieved themselves of the stress of having to provide governance. They don’t even have to think about it, just endlessly repeat “No taxes!” or “Privatize!” or “The government is the problem!” and their job is done.

  13. 13
    Fair Economist says:

    This juxtaposition really struck me:

    A 10 percentage point increase in childhood Medicaid eligibility reduced the rate of high school dropouts by 5 percent and increased completion of a bachelor’s degree by 3.3 to 3.7 percent.

    This random [and stressed] subset subsequently performed worse on intelligence tests and found it harder to resist the chocolate-chip cookies provided for them.

    There’s a famous study showing that little children better able to delay the reward of a marshmallow did, on average, much better in life. It’s really the only study showing a strong correlation between an early childhood mental characteristic and later success. It’s never been explained – lots of hypotheses but nothing demonstrated (partly because a study would take 20 years).

    Could that correlation just reflect less stressed children?

  14. 14
    Mnemosyne says:

    This is an interesting story I heard on local NPR a few days ago about a local charter that focuses on kids in poverty by providing, yes, healthcare, mental health counseling, and parenting classes. (It doesn’t specifically say anything about meals, but that’s pretty likely as well.)

    Note that charters in California are not the same as the for-profit “charter schools” in other states. Out here, they really do tend to have very specific missions and are not intended to serve the general population.

  15. 15
    Anoniminous says:

    There are tens of thousands of papers looking at the effects of stress. The consensus is clear: by whatever criteria, stress is a killer. Literally. People growing up and living in high stress environments have shorter lifespans.

  16. 16
    Mnemosyne says:

    @Fair Economist:

    It’s never been explained – lots of hypotheses but nothing demonstrated (partly because a study would take 20 years).

    IIRC, it was recently explained — the kids who couldn’t wait were getting inconsistent and chaotic parenting where rewards and punishments were given out on a whim, so the kids figured out they should help themselves to the treat rather than wait for an unreliable adult to do it.

    I think one of the ways they did the new test was to have two sets of researchers. The researcher would tell the child that they would have the child do some coloring, but they had forgotten to bring the crayons and would be right back. One set of researchers would come back with a box of crayons or markers, and the other set would come back with an assorted handful of pens and highlighters and say, Oh, sorry, this is all I could find. They would then do the marshmallow test and — surprise, surprise — the kids whose researcher had let them down were more likely to eat the marshmallow sooner, because they figured that the adult was not going to follow through. It was also correlated to the child’s family life — a child with an unreliable family who got an unreliable researcher would eat the marshmallow even sooner.

  17. 17
    Anoniminous says:

    @Fair Economist:

    There’s a famous study showing that little children better able to delay the reward of a marshmallow did, on average, much better in life. It’s really the only study showing a strong correlation between an early childhood mental characteristic and later success. It’s never been explained – lots of hypotheses but nothing demonstrated (partly because a study would take 20 years).

    Could that correlation just reflect less stressed children?

    Yes. No. Ask Again Later.

    The relationships between mental states and neurotransmitters, such as dopamine, are still not fully understood. What is clear is:

    1. constant stress leads to increased dopamine being released in the prefrontal cortex which decreases working memory performance

    2. constant stress is a precursor and cause for anxiety disorders, e.g., PTSD, leading to the development of difficulty in falling or staying asleep, irritability or outbursts of anger, hyper-vigilance, and so on.

    3. There is evidence stress has an epigenetic component which isn’t surprising as epigenetic trait transmission is a way for an organism to respond to immediate environmental conditions

    and so on and so forth.

    There is also evidence (very) rare individuals subjected to high stress environments during childhood can “bootstrap” (sic) themselves out meaning, somehow, they are immune.

    Why and how? I don’t know and I don’t know anyone who does know.

    It may be a child’s ability to defer gratification (marshmallow) is indicative of a genetic (?) predisposition to stress immunity. To find out requires investigation and there is bugger all funding for such.

    ETA: @Mnemosyne: Yes. That is a complicating and/or contributing factor. High stress environments such as poverty implies parents will make promises to their children with every intent of carrying through and then find they can’t, for a host of reasons, along several axis.

  18. 18
    WereBear says:

    @Anoniminous: We know a little more about the mechanisms of stress; for instance, it shuts down the hippocampus, which handles memory.

    Which is why people don’t think and panic at the same. Which is why PTSD is associated with chaotic memory filing, and helping people “file” helps with the symptoms.

    Once you have the stressful childhood, getting to a place of safety and UNstress is extremely helpful. It’s just, also, extremely rare.

  19. 19
    Shakezula says:

    And so we see why Republitarians hate programs that benefit people.

  20. 20
    Anoniminous says:

    @WereBear:

    All of what you say is true.

    The problem is, we know so little about the neurological mechanisms of the Body/Mind Unity. As an example, people purposely seek stressful experiences; the thrill rides in amusement parks wouldn’t exist if we didn’t. It is observed some people will sequential ride a roller coaster. Therefore, it is possible to state the nucleus accumbens (pleasure center) is, somehow, involved in stress stimulus/response.

    Which, given the debilitating affects of stress, is completely daft.

  21. 21
    WereBear says:

    @Anoniminous: If you never got off the roller coaster, it wouldn’t be fun any more.

    Look at routine medical procedures that people get through without too much mental trauma. If a bunch of masked strangers grabbed you and did it, the result would be far different.

    Choice and control are crucial.

  22. 22
    Phoenician in a time of Romans says:

    My wife is recovering from breast cancer now. She has had an operation, with three days in hospital. She is going through four rounds of chemotherapy, with some pretty expensive drugs pumped into her. She is as sick as a dog afterwards, and I have to stay home for a day or three to ensure she doesn’t wind up unable to move on the floor when she heads for the bathroom. After the chemo, she will be going through six weeks of radiotherapy.

    This is pretty stressful.

    It is also essentially free for us – we only pay nominal sums for the drugs, we don’t pay the specialists, we don’t pay the hospital, we don’t pay for the nurse who comes around after each session, we don’t pay for the on-call nursing or emergency services she may need, and, heck, we didn’t even pay for the wig or the cosmetic beauty session the district health board offers female cancer patients who might lose their hair.

    We don’t worry about bankruptcy. We don’t worry about losing our house or taking on another mortgage. We don’t fill out forms or argue with insurance companies. We don’t pay in advance and then hope the insurer reimburses us before our overdrafts run out. We don’t juggle medications based on price, or whether we can afford to both treat her and eat. We simply don’t have THAT stress on top of what we’re going through.

    Needless to say, we don’t live in America.

Comments are closed.