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.
[1] http://www.nber.org/papers/w12352.pdf
[2] http://www.rwjf.org/en/culture-of-health/2012/08/better_educationhea.html
[3] https://www.cdc.gov/media/releases/2012/p0516_higher_education.html
[4] http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf70450
[5] http://www.nber.org/papers/w12352.pdf
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