Education Influences Health

The relationship between education and adult health is one of the strongest, most well-established patterns to emerge from public health research.
Individuals who have completed college can expect that, at age 25, they will live ten years longer on average than those who do not have a high school degree (Hummer and Hernandez, 2013). Educational attainment is also linked to other health outcomes, including lower risk for hypertension and depression, and improved self-rated health (Walsemann et al., 2013). These associations are driven by increased access to material resources — including financial security and access to health benefits — and social resources, such as agency and social capital. Yet, in the United States, systemic racism creates significant barriers to educational attainment for racially minoritized groups. Moreover, systemic racism serves to diminish the health “payoff” of education. Nevertheless, the evidence is clear that a fairer education system means a healthier society. Education is a key social determinant of health and can create a more just society, helping address other root causes of health inequity. The first study to systematically document a relationship between higher levels of education and improved health (sometimes called the “education-health gradient”) in the United States was conducted by Evelyn Kitigawa and Philip Hauser in the early 1970s. Their study examined life expectancy at age 25 (an important measure of adult health) and found that groups with more schooling lived 4-9 years longer than those with less. The study was significantly limited in only examining the U.S. White population. Nonetheless, comparing findings from this early study has helped illuminate two recent critical trends in the education-health gradient. The first key trend since Kitigawa and Houser’s study is the widening of the education-health gap. Ellen Meara and colleagues (Meara, Richards, and Cutler, 2008) found that during the 1980s and 1990s, groups with higher educational attainment experienced dramatic increases in life expectancy, while longevity stagnated for groups with less schooling. As a result, by 2000, there was a seven-year life expectancy gap between those who attended college and those who did not. Even starker, those who attended graduate school lived 12-15 years longer than those who did not finish high school. While the education-health gradient is, on average, becoming steeper over time, recent research has revealed a second concerning trend: the health “payoff” of education is not the same for all groups. Higher educational attainment among Black and Brown adults does not consistently translate to better health outcomes (Assari, 2019; Duarte et al., 2021). Further, when compared to White adults with the same level of education, studies find that Black and Brown’s adults have fewer health returns (Bell et al., 2020) These patterns raise several questions: Why is education so powerfully linked to health? Why would the education-health gap widen over time? And why would the benefits of education on health not be reaped equally across lines of race and ethnicity?  Bruce Link and Jo Phelan (1995) argue that education is a “fundamental cause” of health, providing individuals with a wide range of resources and opportunities which promote health and lower disease risk. Epidemiologists have suggested several specific ways education may improve health: by increasing economic opportunity, fostering agency, and providing greater social capital. (Hummer and Hernandez, 2013; Rogers, Hummer, and Everett, 2013). Yet these pathways overlap and intersect, making specific mechanisms challenging to disentangle. Like a watershed, closing one tributary leads another to open. Thinking of education as a fundamental cause of health operating in tandem with other fundamental causes of health sheds light on the seemingly vexing patterns described above. First, the education-health gradient may be steeper because as socioeconomic gaps grow, education’s “health stakes” increase. We might imagine that in an egalitarian society, higher levels of education could make a moderate difference in one’s health. In a highly stratified society, on the other hand, education may play a more influential role in shaping one’s employment, income, and by extension, access to resources needed for health. For example, when housing is not guaranteed, educational attainment may make the difference between owning a home, renting an apartment, or having no housing. Relatedly, American neighborhoods vary dramatically in their concentrations of health-enhancing (e.g., outdoor recreation areas) and health-harming (e.g., pollution sources) factors, and income influences the neighborhood where one can afford to live. It is well established that housing and neighborhood conditions are critical determinants of health status. Second, racial inequities in the health payoff of education may be mainly due to the racialized character of economic inequalities in the United States. Structural racism created and maintains profound racial inequities in housing, employment, income, and family wealth. These racially structured economic inequalities are exacerbated by interpersonal racism in the workplace, the criminal legal system, and various community settings. Combined, structural and interpersonal racism means that Black, Indigenous, and other people of color (BIPOC) individuals and communities face significant barriers to translating educational gains into health improvements. In sum, thinking of education as a fundamental cause illustrates how racism is implicated in the growing education-health gap and racially disparate health returns on education. Because structural racism produces unequal levels of educational attainment, its attendant health benefits are unequally distributed.  In addition, racism significantly diminishes the health payoff of education for Black, Indigenous, and other people of color (BIPOC) communities and individuals. Finally, understanding education as a fundamental cause cautions against treating education as a singular cure for all of society’s ills. Critical education scholars have repeatedly shown that an unequal education system fails to ameliorate and actively contributes to economic and racial inequalities (Althusser, 1971; Bowles & Gintis, 1976; Willis, 1977; Anyon, 1980; Giroux, 1983). This underscores that for the health benefits of education to be universally achieved, structural racism in the education system must be addressed in tandem with racism in all other aspects of society. Only then will education’s full potential for allowing us to live healthier, more meaningful lives be realized.