By Smita Ghosh

Graduation from high school and college may lead to better overall health. A May 6 report from the Robert Wood Johnson Foundation Commission to Build a Healthier America found a strong and troubling correlation between educational attainment and health.

Like a recent and much-reported (and editorialized-upon) publication from McKinsey & Company about the effects of the achievement gap, the Commission’s report presents the widening gaps in the educational achievement of our nation’s students as social problems with wide-ranging consequences.

The achievement gap in health

Using self-reports of personal health, a widely-used measure in public health studies, the Commission’s health report found that better-educated adults were more likely to report better health. In other words, graduation from high school and graduation from college has a significant positive effect on a person’s health.

The Commission found that, compared with college graduates, adults who have not graduated from high school are more than 2.5 times as likely to report being in poor (“less than very good”) health.

The size of the gap between the health of highly educated and less educated adults varied by state. This gap was largest in California, where 28 percent of the state’s college-educated adults said that they were in less than very good health, compared to 48 percent of all of the state’s residents. As Victoria Colliver of the San Francisco Chronicle cleverly noted, “If states were graded on health status, California would flunk.”

Health and Education

The Commission’s report echoes the work of several scholars who probe the relationship between health and education. In one intriguing example, Professor David Snowdon at the University of Kentucky, has studied a group of nuns in a Minnesota convent for more than 20 years. The unique setting of the “Nun Study” makes for a perfect natural experiment, allowing Snowdon to track the varying physical and social developments of women who live very similar lives.

In 1989, Snowdon and his colleagues found that nuns who had attended college lived significantly longer, and were significantly more likely to be self-sufficient, than those who had only attended high school. Because the nuns in Snowdon’s study lived in identical conditions for most of their lives, his work suggests that some aspect of college attendance, perhaps the mental dexterity developed at school or the underlying individual traits that might drive women to seek education, would have a positive effect on their health.

Social scientists echo Snowdon’s research, indicating a strong connection between health and education that can’t be boiled down to simple explanations. In a paper (PDF) they presented at a 2006 conference at the National Poverty Center, economists David M. Cutler and Adriana Lleras-Muney found that education seems to be correlated with improved health care in a variety of notable ways. Education affected health no matter the type of health outcome scholars used, including the likelihood to develop diseases, the likelihood to survive diseases, and, like the Commission’s report, self reports of health status.

Cutler and Lleras-Muney found that an additional four years of education:

• lowered a person’s five year mortality rate-in other words, the chance they will die in five years-from 11percent to 10.2 percent;
• reduced the risk of heart disease from 31 percent to 29 percent;
• lowered the risk of diabetes from 7 percent to 5.7 percent;
• reduced the probability that an individual will report that they are in fair or poor health by half, from 12 percent to 6 percent; and
• and reduced the average number work days that an individual lost to sickness from 5.15 days annually to 2.85 days a year.

To make the whole thing scarier, a group of researchers noted in a 2008 Health Affairs article that the education-related gap in life expectancy has only grown in recent years. Between 1981 and 2000, the difference in health outcomes between individuals with a high school education or less and individuals with any college education increased by about 30 percent.

According to Cutler and Lleras-Muney, there are a variety of explanations for the correlation between health and education level, but no theory entirely explains the phenomenon.

Why?

One theory holds that success in education and in health could be affected by the same outside factors. Perhaps, for example, people who come from wealthy families tend to be both healthy and well-educated. However, Cutler and Lleras-Muney, in their study of self-reported health in the National Health Interview Survey (NHIS), found that controlling their analysis for a variety of factors (including ethnicity, family income, family size, major activity, region, marital status, and health insurance coverage) did not completely explain the effect that education had on health outcomes. Controlling for these additional factors made the effect of education on health decline by about 40 percent-leaving the effect large and significant.

Other explanations abound. Perhaps better educated people are more likely to be healthy because they tend to make more money, have better jobs or are more likely to have health insurance? But, even when controlling for income, health insurance coverage and job characteristics, the researchers find that education still has a significant effect on health outcomes.

Education and Value of the Future

Some of this relationship, then, must result from more intangible benefits of education. Remember the nuns David Snowdon studied, who had shared an incredibly controlled environment for years, but still exhibited health characteristics late in life that varied with their educational background? Cutler and Lleras-Muney suggest that people with more traditional education may be better consumers of health information and health products, indicating that educational development could help people become healthier. In fact, a 2002 study found that, even when controlling for income and insurance, people with more education were more likely to use drugs that were more recently approved by the FDA, suggesting that they might go out of their way to investigate new developments and manage their own care. Other studies (PDF )note that, even when controlling for income and job characteristics, better-educated people are more likely to avoid long-term risky behaviors like smoking and drug use.

Another approach to understanding the relationship between education and health touches upon our varying approaches to decision-making. Cutler and Lleras-Muney hypothesize that better education and better health might stem from a general interest in long-term planning and future goals. In their value of the future” hypothesis, the researchers contend that individuals who, for any reason, tend to think in long-terms might put more effort into their schooling as well as taking care of their bodies. In another frame, though, education itself might cause one to value the future more highly, making the impact of unequal education reach beyond health outcomes to the very core of our self-concept.

Although the relationship between education and health exists within all races, Cutler and Lleras-Muney contend, at relatively equal margins, they found some evidence that the effect of education on health was larger for whites than for blacks. One possible explanation, the researchers suggest, is that the quality of education is lower for blacks than for whites. Well, there you go. Once again, the achievement gap rears its ugly head.

Smita Ghosh is a Paralegal in the Education Practice of the NAACP Legal Defense and Educational Fund, Inc.