Via Slate comes word of a new study released in the November 2007 issue of American Journal of Public Health. The study tracked the role of class size on a number of outcomes including projected earnings, welfare payments, crime costs, quality-of-life scores, and mortality.
Remarkably, the authors found that, when targeted to low-income students, smaller class size produced savings of approximately $200,000, and a net gain of 1.7 QALYs.
Notwithstanding my dislike of QALYs, this study concludes that reducing class-size could conceivably have a greater effect on socioeconomic disparities and on mortality than most acute care interventions. I have been beating the drum on this general point for some time now, that increasing access to acute care interventions is not an evidence-based way of improving health and ameliorating illness.
Changing the way we conceive of the causes of health and illness is, IMO, the fundamental barrier to improving public health in the U.S. As important as access to care is in a moral paradigm, the evidence, already robust, is mounting that public health policies geared towards the social determinants of health are far and away the most effective means of improving health.
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