Information Age Education
   Issue Number 50
September, 2010   

This free Information Age Education Newsletter is written by David Moursund and Bob Sylwester, and produced by Ken Loge. The newsletter is one component of the Information Age Education project. See and the end of this newsletter.

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Education and Health Care Part 6:
Assessment and Evaluation

"The most dangerous experiment we can conduct with our children is to keep schooling the same at a time when every other aspect of our society is dramatically changing." (Chris Dede, written statement to the PCAST panel, 1997.)

This is the sixth in a sequence of IAE Newsletters based on comparing Education and Health Care. The underlying goal is to gain increased insight into ideas that might lead to improvement of our educational systems.

The term improve suggests the need for change—in a manner that leads to improvements. It suggests the need for clear goals, along with valid, reliable, fair assessment instruments for gathering data relevant to formative, summative, and long-term residual impact evaluation.

The “bottom line” in both Education and Health Care are the customers—the students and patients. Different groups of people have differences of opinion as to goals in Education and in Health Care. Thus, there are different opinions as to what might constitute improvement.

International Comparisons

In both Education and Health Care there are studies that attempt to compare how well various countries are doing. It is difficult to compare health care among countries. However, there is considerable data suggesting the U.S. health care system is not the best in the world (Docteur & Berenson 2009).  And, suppose it were the best? Obviously there would still be room for immense improvements.

It is also difficult to compare the quality of education systems in different countries. Different countries set different goals and have differing opinions as to what is important. However, serious efforts have been made to compare the success of education in literacy, science, and math among different countries. Such studies suggest that a number of countries are outdoing us in selected curriculum areas (ECS 2010).

Cost effectiveness is a key issue, since financial resources are limited. Thus, as we look at assessment and use of assessment data in the two disciplines, one issue to keep in mind is the cost effectiveness. Here is a health care example:

In a series of important papers, David Cutler, Mark McClellan, and their coauthors have argued persuasively that the benefits from many technological innovations more than justify the rising costs of health care.

… the most striking evidence came from the rapid decline in mortality following heart attacks or acute myocardial infarction. Briefly, they found that between 1984 and 1998, the costs of treating heart attacks rose by ten thousand dollars in real terms, but life expectancy increased by about one year. In short, technological innovations in the treatment of cardiac disease provided terrific value for the dollar; in this case, the rising costs were “worth it.” (Skinner et al. 2006).

Comparing cost effectiveness in Education and Health Care is definitely like comparing apples to oranges. Consider our relatively large investment in students who are identified as meeting certain disability conditions as defined in the Federal Individuals with Disabilities Education Act (IDEA). We do not measure success by extended length of life. Instead, we measure success by increased quality of life, self-sufficiency, contribution to the nation’s productivity, and so on.

Longitudinal Assessment

How can we tell if Education or Health Care is getting better? One way is to analyze a particular type of well-defined problem. Health Care can point to the problem of measles, where we in the United States once had millions of cases per year and now have less than 200 cases per year. The worldwide eradication of smallpox provides another excellent example.

In Health Care, we can also look at very difficult problems, such as AIDS. This disease is being fought worldwide. The popular press keeps us informed on progress—and, the lack thereof—in treatment, prevention, and incidence of the disease.

In education, we can gather data on the percentage of students who graduate from high school with their age cohort. Our nation has set a high priority on increasing the percentage of students who graduate from high school or who obtain a still higher level of formal schooling. We know, of course, that “graduation from high school” is a very broad term, with huge differences between the learning of different students.

More About Education

In education, we can track students over a number of years and attempt to find causal relationships between performance and treatment (class sizes, qualifications of teachers, and so on). For example, John Friedman (2010) presents results from tracking a large number of kindergarten students well into adulthood. He found that smaller classes and more experienced teachers contribute to above average success in Kindergarten, and such above average early success is a predictor of continuing above average success.

Literacy is one of the problem areas and a major source of goals in education.  However, research in this area requires agreeing on a definition of literacy and the development of valid, reliable, and fair measurement of literacy. Currently, an “average” adult in the United States reads at a 7th or 8th grade level. Quoting from

A five-year, $14 million [26,700 subjects] study of U.S. adult literacy involving lengthy interviews of U.S. adults, the most comprehensive study of literacy ever commissioned by the U.S. government, was released in September 1993. … This government study showed that 21% to 23% of adult Americans were not "able to locate information in text", could not "make low-level inferences using printed materials", and were unable to "integrate easily identifiable pieces of information." …

A follow-up study by the same group of researchers using a smaller database (19,714 interviewees) was released in 2006 that showed no statistically significant improvement in U.S. adult literacy. These studies assert that 46% to 51% of U.S. adults read so poorly that they earn "significantly" below the threshold poverty level for an individual.

In the second quoted paragraph, notice the attempt to develop a cost benefit analysis, by linking poor reading skills with a poverty level of income. The reader might be led to believe that if we develop interventions that significantly decrease illiteracy, the result would be a significant increase in the future income level of those who had gained in their level of literacy. Your authors view this as an assertion that cannot be justified on the basis of the type of research that was carried out.

More About Health Care

The Health Care system in the United States is proud of its long-term progress. The Journal of the American Medical Association (1999) discusses ten great public health achievements in the United States, 1900–1999. Here are several quotes from this article:

During the 20th century, the health and life expectancy of persons residing in the United States improved dramatically. Since 1900, the average lifespan of persons in the United States has lengthened by more than 30 years; 25 years of this gain are attributable to advances in public health.

Control of infectious diseases has resulted from clean water and improved sanitation. Infections such as typhoid and cholera transmitted by contaminated water, a major cause of illness and death early in the 20th century, have been reduced dramatically by improved sanitation. In addition, the discovery of antimicrobial therapy has been critical to successful public health efforts to control infections such as tuberculosis and sexually transmitted diseases (STDs).

Healthier mothers and babies have resulted from better hygiene and nutrition, availability of antibiotics, greater access to health care, and technologic advances in maternal and neonatal medicine. Since 1900, infant mortality has decreased 90%, and maternal mortality has decreased 99%.


In both Education and Health Care we assess individuals. “How is that patient doing?” “How is that student doing?” In both cases, we can think of these as formative evaluation questions. We want answers that lead to improvements in the treatment of the patient and improvement in the education of the student.

In Health Care, quality of life is a major consideration. This is perhaps most evident when the patient is dying and is going to die in a relatively short period of time  An excellent article by Atul Gawande in the 8/2/2010 issue of The New Yorker discusses this issue and hospice in considerable detail.
The education of students with disabilities as defined by IDEA gives an indication of how our education is able to provide special services for a designated part of the population. For this group of students, there is considerable emphasis on quality of life. This emphasis helps to guide and unify the overall Individual Education Program (IEP) for a student that may well continue for a great many years.

Many educators have looked at this IEP approach—education designed to help students be all that they can be—and wondered why our entire education system cannot be that way. One answer to this question is that we have not yet figured out how to provide this quality of education with the amount of money we are willing to spend on education. Another answer may be that we are so locked into our traditional curriculum content, instructional processes, and assessment that we are not able to make such a major change.

Final Remarks

Both Education and Health Care understand basic issues of quality of life. The two disciplines make use of their understanding of quality of life in different ways. As Gawamde (8/2/2010) points out, patients gaining an increased understanding of personal meanings of quality of life and can play a significant role in making health care decisions that affect their quality of life.

Our education system makes an effort to help students understand that the education they are involved in will affect their quality of life in the future. However, we currently are not as successful as we would like in having students gain personal ownership and understanding of this idea.


Docteur, Elizabeth and Robert Berenson (2009). How does the quality of U.S. health care compare internationally? Robert Wood Johnson Foundation. Retrieved 9/5/2010 from

ECS (2010). International comparisons. Education Commission of the States. Retrieved 9/5/2010 from

Friedman, John (2010).  Research shows a good kindergarten education makes dollars and cents. National Science Foundation Press Release. Retrieved 8/13/2010 from

Gawamde, Atul (8/2/2010). Letting go: What should medicine do when it can’t save your life? The New Yorker. Retrieved 9/6/2010 from

JAMA (1999). Ten great public health achievements—United States, 1900–1999. Journal of the American Medical Association. Retrieved 8/12/2010 from

Skinner, Jonathan, Douglass Staiger and Elliott Fishcer (2006). Is technological change in medicine always worth it? The case of acute myocardial infarction. PubMed Central. Retrieved 8/13/2010 from

About Information Age Education, Inc.

Information Age Education is a non-profit organization dedicated to improving education for learners of all ages throughout the world. IAE is a project of the Science Factory, a 501(c)(3) science and technology museum located in Eugene, Oregon. Current IAE activities include a Wiki with address, a Website containing free books and articles at, and the free newsletter you are now reading.

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