Friday, June 10, 2016

The Mysterious Connection Between Education and Health

Don Siegel

While youth development work involves many things, perhaps no outcome is more important than promoting health and well-being. Although, programs may or may not have components that most people associate with health promotion such as: physical activity, nutrition counseling, drug prevention, sex education, and violence avoidance, their support for educational attainment (years of schooling) is probably the single most potent factor in health promotion.  For many people this may appear to be a strange statement, as it would seem that directly addressing various health promoting or compromising behaviors would have the greatest “bang for the buck”, but a large body of research is showing that educational attainment is the single most important factor related to health across one’s life span.

Support for this contention comes from the many relationships that exist between education and markers of health. To get a sense of what I am writing about various studies have shown that people with more years in school have reduced morbidity from heart conditions, stroke, hypertension, elevated cholesterol, emphysema, diabetes, asthma, and ulcers.[1] As well, infant mortality rates are about half as large for mothers with 16 or more years of education than for mothers with 11 years or less. Educational attainment is also connected to longevity with college graduates living 5 years longer than individuals who have not finished high school (men – 79.7  vs. 72.9; women 83.5 vs. 78.4)![2]

Seemingly, such health outcomes could be mediated by a number of variables other than educational attainment, but evidence also exists that connects educational attainment to health promoting behaviors. For example, those with more years of schooling are less likely to smoke, to drink a lot, to be overweight or obese, or to use illegal drugs. Better educated individuals are also more likely to exercise and to obtain preventive care such as flu shots, vaccines, mammograms, pap smears, colonoscopies, to use seat belts, to have a house with a smoke detector and to have tested their house for radon.[3]

Again, while no one can definitively explain the causal connections between educational attainment, health behaviors, and health outcomes, a number of ideas have been advanced over the years that may mediate the relationships. These include, but are not limited, to the following:

1.     Environmental Argument: More education typically leads to greater incomes, which, in turn, provides more control over where one lives. Neighborhoods are associated with such things as housing quality, safety, proximity to supermarkets, access to recreation, availability of health providers, and the quality of air and water. Along with the physical environment, health is linked to the social environment in a neighborhood. Neighborhoods in which residence have stronger bonds have been shown to be places in which residents are more likely …to work together to achieve common goals such as
cleaner and safer public spaces, healthy behaviors and good schools; to exchange
information regarding childcare, jobs and other resources that affect health; and to
maintain informal social controls discouraging crime or other undesirable behaviors
such as smoking or alcohol use among youths, drunkenness, littering and graffiti—
all of which can directly or indirectly influence health.[4] Another version of the environmental contention is that more highly educated people get “better” jobs that, in addition to paying higher incomes and providing health insurance, offer safer work environments. In essence, this stream of thinking connects education with jobs, which are invariably connected with income and, in a variety of ways, with the environments that people either chose or a forced to live in. While researchers contend that the linkages between environment and health are complex, with research still to be done, they also assert that the overwhelming evidence is that the physical and social environments in which people live are strong predictors of their health, and that income, which is largely determined by education, is a critical factor in where people chose to live.

2.     Social Networks: Another aspect of the social environment is the support one gets from people around them. More educated persons have been shown to have larger social systems for financial, physical and emotional support.  Peer approval/disapproval can also effect whether one engages in high-risk behaviors. Thus, this theory contends that if more educated people associate with more educated friends, who are more likely to behave healthily and value health, the peer effects of networks will self propagate.  This does not only relate to adults, but to children whose social network includes their parents. Indeed, the connection between a parent’s education and their child’s health is very strong. Consequently, the education-health connection has a cross-generational-cascading effect in which more educated parents have healthier children, who, in turn become more educated and are healthier. They, in turn, live in healthier neighborhoods and associate with others who value healthy behaviors. Here, education, income, and social networks are interconnected, and are directly related to the subcultures that emerge. One need only observe the prevalence of parks, fitness clubs, supermarkets promoting organic foods, fast-food restaurants, and liquor stores in a community to get a sense of what it values with regard to healthy lifestyles.

3.     Future Optimism:  If education leads to higher income, greater control over one’s life, and generally improves one’s outlook on the future, individuals may be more likely to behave in ways to protect that future. On the other hand, less educated individuals may engage in riskier behaviors since the value of living to an advanced age is lower, and probably seen as less likely. Here, a psychological perspective that perceives a future filled with success and happiness, logically leads to a desire to protect one’s current and future health. On the other hand for folks living under duress, and who see little likelihood for change, the opposite may be true. As Bob Dylan’s song Like a Rolling Stone proclaims, When you ain't got nothing, you got nothing to lose. With little to lose, engaging in an array of health compromising activities may provide instant gratification, but do so at the expense of longer-term health. Thus, more or less education is connected to investing or not investing in one’s future, and a more or less hopeful future determines whether or not one engages in health enhancing or health compromising activities.

4.     Information and Cognitive Skills: This idea connotes that more educated people are better informed, and, thus, make use of health related information to a greater extent than less educated individuals. For example, people with more years of education were more likely to quit smoking after the Surgeon General’s 1964 report that definitively linked smoking with lung cancer. It is also hypothesized that persons with more years of education have a greater awareness and understanding of modern ideas about nutrition, exercise, drug and alcohol abuse, and the most effective ways to manage diseases. Another variation on this theme is that more educated persons may not only be more aware of recent information about health, but also have greater regard for scientific findings, and, thus, be more willing to change their behavior accordingly. Higher educational attainment may also be connected to developing higher-level critical thinking and decision skills, which are essential to the regulation and control of behavior.

In summary, it is evident that health is intricately and powerfully connected with educational attainment. While the connections are complex, the emerging picture seems to reveal that educational attainment impacts such things as future income, which effects many of the choices that people can make about their lives including where they live, who they associate with, and how they think about their futures. Education also affects the access that people have to information, how they think about current health issues, and their willingness to act rationally to enhance their lives. Of critical importance is how the educational attainment of a parent affects their children with regard to a child’s own educational attainment, and the concomitant health benefits that accrue from such. So it appears that youth development programs that include activities such as sports, nutrition, violence prevention, and drug education are serving an immediate need to get kids on track to live healthy lives. To sustain these efforts, educational attainment is critical, and those programs that support the educational success of their participants are doing work that is truly transformative when considering their future health and well-being.