Sociology Education and Health
by
Robert A. Hummer, Lauren M. Perry
  • LAST MODIFIED: 26 August 2013
  • DOI: 10.1093/obo/9780199756384-0096

Introduction

The relationship between education and health comprises important portions of the sociological, social science, and public health literatures. Over the last half-century, sociologists, economists, epidemiologists, and other health scientists have documented that people with higher levels of education live longer and healthier lives, on average, than people with lower levels of education. The education–health association is not uniform, though, either across time or when population subgroups or geographic areas are compared. Thus, a great deal of scientific work documents temporal, geographic, and demographic differences in the overall education-health association. Moreover, the strength of the education–health relationship tends to differ depending on which health outcome(s)—self-rated general health, the presence or absence of chronic conditions, whether or not individuals become physically disabled late in life, and so on—is the object of study. All told, there is a great deal of work in sociology, demography, and related disciplines dedicated to the accurate description of educational differences in health outcomes across population subgroups, over time, and for specific geographic areas. Beyond accurate description, the education–health literature is also characterized by important debates regarding the extent to which education is either simply correlated with health or whether education causally influences health outcomes. If education is causally related to health, what are the key mechanisms by which it does so? On the other hand, is the relationship between education and health spurious, that is, the result of factors that are common to both education and health (such as intelligence or parents’ socioeconomic background)? Scientific research tackling such issues is at the forefront of work in this area of study, in large part because the issue of causality is so central to policy debates surrounding education’s role in future improvements in population health. This article touches on the classic works, key scientific resources, important descriptive papers, and central debates that characterize this area of study.

Classic Works and General Overviews

The single most important classic work of scholarship in the area of education and health is Kitagawa and Hauser 1973. The authors amassed a data set based on 1960 US vital statistics and census records to document mortality differentials by educational attainment for women and men, for younger and older adults, and for the white and non-white populations. Their classic work served to greatly heighten awareness that educational attainment was related to major disparities in mortality rates and continues to be a takeoff point for many studies in the area. Recent works, such as Cutler and Lleras-Muney 2008, Ross and Mirowsky 2010, and Hummer and Lariscy 2011, most effectively serve to update scholarship in this area. No single theoretical perspective or empirical tradition dominates the education–health literature. Bruce Link and Jo Phelan’s fundamental cause theory of health argues that educational attainment is a flexible resource that individuals use to navigate the life course in healthier ways compared to people with less education (Link and Phelan 1995); when new technologies or challenging situations arise, it is people with higher levels of education who are best equipped to use the new technologies or effectively confront the challenges that lead to their overall higher levels of health and longevity. Mirowsky and Ross 2003 specifically emphasizes the human capital benefits that individuals develop with higher levels of education. They argue that higher levels of schooling provide individuals with the skills and resources that, far beyond the increased income associated with higher education, are necessary to live healthier and longer lives. Baker, et al. 2011 further develops this line of thinking by focusing on the cognitive skills that education helps develop and that are related to better health across the life course.

  • Baker, David P., Juan Leon, Emily G. Smith Greenaway, John Collins, and Marcela Movit. 2011. The education effect on population health: A reassessment. Population and Development Review 37.2: 307–332.

    DOI: 10.1111/j.1728-4457.2011.00412.xSave Citation »Export Citation »E-mail Citation »

    Baker and colleagues focus on three objectives: (1) assessing the causal role of education in improved population health around the world, (2) thoroughly documenting the robustness of education’s effect on health, and (3) developing the hypothesis that education improves health through its effect on the development of high-order cognitive skills.

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    • Cutler, David M., and Adriana Lleras-Muney. 2008. Education and health: Evaluating theories and evidence. In Making Americans healthier: Social and economic policy as health policy. Edited by Robert F. Schoeni, James S. House, George A. Kaplan, and Harold Pollack, 29–60. New York: Russell Sage Foundation.

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      Cutler and Lleras-Muney provide a comprehensive overview of the relationship between education and health. They document current US educational differences in health behaviors, health, and mortality. The authors also examine possible mechanisms accounting for the education–health relationship and discuss policy implications related to education and health.

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      • Hummer, Robert A., and Joseph T. Lariscy. 2011. Educational attainment and adult mortality. In International handbook of adult mortality. Edited by Richard G. Rogers and Eileen M. Crimmins, 241–261. New York: Springer.

        DOI: 10.1007/978-90-481-9996-9Save Citation »Export Citation »E-mail Citation »

        The authors provide an extensive overview of research on education and adult mortality. They provide a conceptual framework for understanding educational disparities in adult mortality and show basic patterns in this relationship. They discuss variation in the association over time, and across population subgroups and geographic contexts. Policy implications are discussed.

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        • Kitagawa, Evelyn M., and Philip M. Hauser. 1973. Differential mortality in the United States: A study in socioeconomic epidemiology. Cambridge, MA: Harvard Univ. Press.

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          Using US data from 1960, Kitagawa and Hauser match death certificates of adults to census data using educational attainment as a measure of socioeconomic status. They find that higher educated individuals have lower rates of mortality than less educated individuals. Mortality differentials were greater among younger individuals and women.

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          • Link, B. G., and Jo Phelan. 1995. Social conditions as fundamental causes of disease. Journal of Health and Social Behavior 35:80–94.

            DOI: 10.2307/2626958Save Citation »Export Citation »E-mail Citation »

            Link and Phelan argue that social factors, including education, are fundamental causes of disease because they affect access to resources and multiple disease outcomes and maintain a relationship with health and disease outcomes despite changes in intervening mechanisms.

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            • Mirowsky, John, and Catherine E. Ross. 2003. Education, social status, and health. New York: de Gruyter.

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              Mirowsky and Ross conduct a thorough analysis of the association between education and health in the United States. They argue that education is the “root cause” of health because it provides individuals with resources to shape and promote their health. They find that individuals with higher educational attainment have favorable health across many outcomes.

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              • Ross, Catherine E., and John Mirowsky. 2010. Why education is the key to socioeconomic differentials in health. In The handbook of medical sociology. 6th ed. Edited by Chloe E. Bird, Peter Conrad, Allen M. Freemont, and Stefan Timmermans, 33–51. Nashville: Vanderbilt Univ. Press.

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                The authors explain why people with higher education have better health than those with lower education and why this inequality grows with age. They describe different mediators of the education–health association and contrast the conceptualization of education as human capital, which increases effective agency, with the conceptualization of education as a commodity.

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                Journals

                There is no single academic journal that focuses on the area of education and health. Instead, studies are scattered across many journals in sociology, demography, economics, public health, and medicine. Studies of education and health in sociological journals (such as the American Sociological Review and the Journal of Health and Social Behavior) tend to be longer and are more theoretically developed than those in public health (such as the American Journal of Public Health and Health Affairs), which tend to be shorter and more policy-oriented. Articles on education and health in interdisciplinary social science journals such as Demography and Social Science and Medicine tend to be intermediate in length and quite technical. Any comprehensive understanding of the education and health literature needs to be drawn from the journals highlighted here, as well as others, and needs to be interdisciplinary in nature rather than focused on just one scientific discipline.

                Data Sources

                There is no single data set that researchers use to study the relationship between education and health. All of the best data sets that do so, however, share two important characteristics: (1) they are nationally representative; and (2) they use state of the art survey methods to collect data. The US governmental data sets featured below, the National Health Interview Survey (NHIS) and the National Health and Nutrition Examination Survey (NHANES), are both cross-sectional data sets that contain measures of educational attainment and many health behaviors and health outcomes. Importantly, both data sets are statistically linked to follow-up mortality records so that researchers can study who lives and who dies in the years subsequent to the surveys (National Health Interview Survey Linked Mortality Files (NHIS-LMF); National Health and Nutrition Examination Survey III Linked Mortality File). The longitudinal Americans’ Changing Lives (ACL) and Health and Retirement Study (HRS), respectively, provide data that allow researchers to examine the extent to which education affects health outcomes and health behaviors as people age. The Survey of Health, Ageing, and Retirement in Europe (SHARE) data collection effort in European countries is similar to the US-based HRS data set and allows for the comprehensive assessment of education and health outcomes among the aging populations of a wide range of countries. Finally, the Demographic and Health Surveys (DHS) is a major initiative in more than ninety countries around the world that facilitates the study of education and health in developing countries.

                Education and Health Outcomes

                Scientific literature on the relationship between education and health outcomes is extensive. Here, we divide the general literature covering this area into three subsets: (1) studies focusing on physical health outcomes, (2) studies focusing on health behavior, and (3) studies focusing on mortality.

                Physical Health

                In this set of studies, scholars document the relationship between education and physical health outcomes such as self-rated health, physical functioning, and the presence or absence of chronic health conditions. Zajacova, et al. 2012 provides the most recent documentation of the association between education and self-rated health among US adults. Ross and Wu 1995 proposes key pathways by which education influences health in the United States and tests those potential explanations. Mirowsky and Ross 1998 refines thinking on education and health by introducing the human capital perspective: that education influences health even outside of the increased income pathway. Ross and Mirowsky 1999 later test whether years of education, educational credentials, or college selectivity matter most for the health of adults and find that years of education matters most; this supports their human capital thesis. Walsemann, et al. 2012 further show that obtaining a higher level of education between the ages of twenty-five and forty can have important positive impacts on health in mid-life. Using longitudinal data among American adults fifty and older, Smith 2004 shows that education, rather than income or wealth, is the key socioeconomic resource that matters for more favorable later life health outcomes.

                • Mirowsky, John, and Catherine E. Ross. 1998. Education, personal control, lifestyle, and health: A human capital hypothesis. Research and Aging 20.4: 415–449.

                  DOI: 10.1177/0164027598204003Save Citation »Export Citation »E-mail Citation »

                  Mirowsky and Ross hypothesize that education improves health because it increases effective agency. Going far beyond increased income, education’s impact on increased effective agency helps individuals to incorporate healthy behaviors into their lifestyles and increase their sense of control. Using a national data set, they show clear support for their human capital hypothesis.

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                  • Ross, Catherine E., and John Mirowsky. 1999. Refining the association between education and health: The effects of quantity, credential, and selectivity. Demography 36.4: 445–460.

                    DOI: 10.2307/2648083Save Citation »Export Citation »E-mail Citation »

                    Ross and Mirowsky show that physical functioning and self-rated health are much more favorable among US adults with more years of education and among those who attended highly selective colleges. Beyond years of schooling, educational credentials (i.e., degrees) exhibit no impact on health.

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                    • Ross, Catherine E., and Chia-ling Wu. 1995. The links between education and health. American Sociological Review 60.5: 719–745.

                      DOI: 10.2307/2096319Save Citation »Export Citation »E-mail Citation »

                      This classic paper spells out potential explanations for the education–health relationship and, using two data sets, tests those explanations. Ross and Wu find that higher education is related to better physical health because of improved work and economic conditions, enhanced social-psychological resources, and more favorable health behavior.

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                      • Smith, James P. 2004. Unraveling the SES-health connection. Population and Development Review 30:108–132.

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                        In a clever use of longitudinal data, Smith asks whether education, income, or wealth influences health changes among individuals age fifty and older. He finds that education has, by far, the strongest impacts on health. He then addresses some of the reasons why education’s effects seem to be so much more powerful than income or wealth.

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                        • Walsemann, Katrina M., Bethany A. Bell, and Robert A. Hummer. 2012. Effects of timing and level of degree attained on depressive symptoms and self-rated health at midlife. American Journal of Public Health 102.3: 557–563.

                          DOI: 10.2105/AJPH.2011.300216Save Citation »Export Citation »E-mail Citation »

                          The authors examine whether receiving a higher educational degree after age twenty-five is associated with fewer symptoms of depression and better self-rated health at midlife. Individuals who obtain a bachelor’s degree between the ages of twenty-five and forty tend to have fewer symptoms of depression and better self-rated health than those who do not obtain more education in this age range.

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                          • Zajacova, Anna, Robert A. Hummer, and Richard G. Rogers. 2012. Education and health among U.S. working-age adults: A detailed portrait across the full educational attainment spectrum. Biodemography and Social Biology 58.1: 1–22.

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                            Zajacova and colleagues provide estimates of health inequalities among US adults by detailed level of educational attainment, including six postsecondary levels. Adults with the highest degrees have much better self-rated health than those with lower educational degrees. Economic indicators and health behaviors explain 40 percent of the education–health relationship.

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                            Health Behavior

                            People with higher levels of education tend to exhibit healthier behaviors than people with lower levels of education. Pampel, et al. 2010 conducts a thorough review of the literature in this area and develops nine potential explanations of why low education is related to poorer health-related behavior. Cutler and Lleras-Muney 2010 uses data from the United States and the United Kingdom to test explanations for wide educational differences in health behavior. De Walque 2004 gives specific attention to why low education has come to be so highly correlated with smoking in many countries. Goldman and Smith 2002 shows that high education is related to more effective self-management of diseases, while Lleras-Muney and Lichtenberg 2005 shows that highly educated individuals are often the first people to use newly developed medicines. Finally, the classic paper by Rosenzweig and Schultz 1989 shows that highly educated couples exhibit greater knowledge of contraceptives and are more likely to use contraceptives effectively.

                            • Cutler, David M., and Adriana Lleras-Muney. 2010. Understanding differences in health behaviors by education. Journal of Health Economics 29.1: 1–28.

                              DOI: 10.1016/j.jhealeco.2009.10.003Save Citation »Export Citation »E-mail Citation »

                              Cutler and Lleras-Muney study education differences in health behavior using data from the United States and the United Kingdom. Thirty percent of the relationship between education and health behavior is explained by income, health insurance, and family background, while increased knowledge and cognitive ability account for another 30 percent. Social networks account for 10 percent.

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                              • de Walque, Damien. 2004. Education, information, and smoking decision: Evidence from smoking history, 1940–2000. World Bank Policy Research Working Paper 3362:1–30.

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                                De Walque assesses whether education improves health and life expectancy by examining reconstructed smoking histories. He finds that smoking decreased earlier and dramatically for people with college degrees after 1950 when information about the hazards of smoking began to spread. Further, highly educated individuals are more likely to quit smoking.

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                                • Goldman, Dana P., and James P. Smith. 2002. Can patient self-management help explain the SES health gradient? Proceedings of the National Academy of Sciences of the USA 99.16: 10929–10934.

                                  DOI: 10.1073/pnas.162086599Save Citation »Export Citation »E-mail Citation »

                                  The authors study differences in treatment adherence by education level for patients with HIV and diabetes. Findings show that higher educated people with HIV or diabetes are more likely to adhere to treatment, which improves their health. Less educated diabetics are more likely to switch treatments, worsening their general health.

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                                  • Lleras-Muney, Adriana, and Frank R. Lichtenberg. 2005. Are the more educated more likely to use new drugs? Annals of Economics and Statistics 79.80: 671–696.

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                                    Lleras-Muney and Lichtenberg find that more educated people are more likely to use new medicines. Also, education seems to matter only for those who buy medicine frequently for a condition, which could mean that finding high-quality treatment is less costly for more highly educated people.

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                                    • Pampel, Fred C., Patrick M. Krueger, and Justin T. Denney. 2010. Socioeconomic disparities in health behaviors. Annual Review of Sociology 36:349–370.

                                      DOI: 10.1146/annurev.soc.012809.102529Save Citation »Export Citation »E-mail Citation »

                                      Pampel and colleagues document education and income differences in health behavior among US adults. Based on their review of the literature, they develop nine potential explanations for why people with lower levels of education and income exhibit poorer health behavior than their more highly educated and higher income counterparts.

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                                      • Rosenzweig, Mark R., and T. Paul Schultz. 1989. Information and non-market productivity: Contraceptive use and its effectiveness. International Economic Review 30.2: 457–477.

                                        DOI: 10.2307/2526657Save Citation »Export Citation »E-mail Citation »

                                        The authors investigate the relationship between education and couples’ knowledge and use of contraceptives. The results show that more highly educated couples have broader knowledge of contraceptive methods and use them more effectively.

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                                        Mortality

                                        Demographers and other health scientists document educational differences in mortality using increasingly larger data sets and more sophisticated study designs. Elo and Preston 1996 and Backlund, et al. 1999 first showed that educational attainment differentiated mortality rates even among those with relatively high levels of education. More recently, Montez, et al. 2012 comprehensively documented the functional form of the education–mortality association in the United States. They showed a linear decline in mortality risk as educational attainment increased from zero to eleven years, a step-change reduction in mortality risk upon receipt of a high school diploma, and a steeper decline in mortality risk with more and more years of education beyond high school. Rogers, et al. 2010 similarly showed that mortality decreased among individuals with increasingly advanced degrees, all the way up through PhD recipients. Finally, Brown, et al. 2012 demonstrated that educational attainment is related to greater longevity in the US population as well as to greater compression (i.e., less dispersion) around the average age of death for both women and men.

                                        • Backlund, Eric, Paul D. Sorlie, and Norman J. Johnson. 1999. A comparison of the relationships of education and income with mortality: The national longitudinal mortality study. Social Science and Medicine 49.10: 1373–1384.

                                          DOI: 10.1016/S0277-9536(99)00209-9Save Citation »Export Citation »E-mail Citation »

                                          The authors use data on more than four hundred thousand men and women to compare the relationships of education and income with mortality in the United States. They find differences in mortality at the lower end of socioeconomic status that they attribute to income and differences at the higher end that they attribute largely to education.

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                                          • Brown, Dustin C., Mark D. Hayward, Jennifer Karas Montez, Robert A. Hummer, Chi-Tsun Chiu, and Mira M. Hidatjat. 2012. The significance of education for mortality compression in the United States. Demography 49.3: 819–840.

                                            DOI: 10.1007/s13524-012-0104-1Save Citation »Export Citation »E-mail Citation »

                                            The authors study whether US educational attainment is related to differences in length of life as well as with old-age mortality compression. They hypothesize that both longevity and compression increase with higher educational attainment and that highly educated women have the greatest longevity and mortality compression. The hypotheses are supported.

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                                            • Elo, Irma T., and Samuel H. Preston. 1996. Educational differentials in mortality: United States, 1979–85. Social Science and Medicine 42.1: 47–57.

                                              DOI: 10.1016/0277-9536(95)00062-3Save Citation »Export Citation »E-mail Citation »

                                              Elo and Preston thoroughly document education differentials in US adult mortality, with comparisons to European countries as well. They find that mortality decreases with each additional year of schooling and that differentials are larger for working age adults and men than for the elderly and women. US and European educational differences in mortality are similar.

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                                              • Montez, Jennifer K., Robert A. Hummer, and Mark D. Hayward. 2012. Educational attainment and adult mortality in the United States: A systematic analysis of functional form. Demography 49.1: 315–336.

                                                DOI: 10.1007/s13524-011-0082-8Save Citation »Export Citation »E-mail Citation »

                                                The authors use data on non-Hispanic white and black adults to document the functional form between educational attainment and mortality. Results show a linear decline in mortality from zero to eleven years of education, a step-change reduction in mortality risk upon receipt of a high school diploma, and a steeper decline in mortality with increasing years beyond high school.

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                                                • Rogers, Richard G., Bethany G. Everett, Anna Zajacova, and Robert A. Hummer. 2010. Educational degrees and adult mortality risk in the United States. Biodemography and Social Biology 56.1: 80–99.

                                                  DOI: 10.1080/19485561003727372Save Citation »Export Citation »E-mail Citation »

                                                  The authors provide the first US estimates of mortality risk for people with specific educational degrees, including postsecondary degrees. They find that people with higher educational degrees are far less likely to die during the six-year study follow-up period than people with just a high school diploma. However, this finding varies by both gender and birth cohort.

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                                                  Education and Health Outcomes: Subgroup Differences

                                                  A burgeoning research literature finds that the strength of the relationship between educational attainment and health outcomes varies across age, gender, and race/ethnic subgroups of the population. The following subsections highlight such subgroup differences in the education–health relationship.

                                                  Age

                                                  The key question underlying age patterns in the education–health relationship is whether the association weakens at older ages, termed the “age-as-leveler” hypothesis, or whether the association strengthens with age, termed the “cumulative advantage” hypothesis. House, et al. 1994 provides a very useful summary of this debate for health outcomes, while Crimmins 2005 does so for mortality. Beckett 2000 finds a weaker association between education and health at older ages. However, most studies find that the effects of educational attainment on health strengthen with age, at least through age eighty or so. Ross and Wu 1996, Mirowsky and Ross 2008, and Lynch 2003 provide the strongest evidence that the education–health relationship strengthens with age, and both Lynch 2003 and Mirowsky and Ross 2008 suggest that such a pattern is becoming even stronger among more recent birth cohorts of adults.

                                                  • Beckett, Megan. 2000. Converging health inequalities in later life: An artifact of mortality selection? Journal of Health and Social Behavior 41.1: 106–119.

                                                    DOI: 10.2307/2676363Save Citation »Export Citation »E-mail Citation »

                                                    Beckett examines how age affects the association between education and health. She finds a convergence of educational health inequalities in the elderly that is robust to sample selection processes, which offers support for the age-as-leveler perspective.

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                                                    • Crimmins, Eileen M. 2005. Socioeconomic differentials in mortality and health at older ages. Genus 61:163–176.

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                                                      Crimmins documents educational differences in mortality in old age and discusses how mortality differentials earlier in life affect differentials at older ages. She provides an excellent discussion of the issue of mortality selection.

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                                                      • House, James S., James M. Lepkowski, Ann M. Kinney, Richard P. Mero, Ronald C. Kessler, and A. Regula Herzog. 1994. The social stratification of aging and health. Journal of Health and Social Behavior 35:213–234.

                                                        DOI: 10.2307/2137277Save Citation »Export Citation »E-mail Citation »

                                                        The authors develop and evaluate a theory that education disparities in health increase with age until they eventually decrease because of selection or equalization of health risks at old age. Results indicate that educational disparities become stronger with age because people of lower education are exposed to psychological factors that negatively affect health over the life course.

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                                                        • Lynch, Scott. 2003. Cohort and life-course patterns in the relationship between education and health: A hierarchical approach. Demography 40.2: 309–331.

                                                          DOI: 10.1353/dem.2003.0016Save Citation »Export Citation »E-mail Citation »

                                                          Lynch analyzes how cohorts affect the impact of education on life-course health trajectories using two national data sets. The findings show that the effect of education increases across age, and that the pattern is increasing across cohorts.

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                                                          • Mirowsky, John, and Catherine E. Ross. 2008. Education and self-rated health: Cumulative advantage and its rising importance. Research on Aging 30:93–122.

                                                            DOI: 10.1177/0164027507309649Save Citation »Export Citation »E-mail Citation »

                                                            Mirowsky and Ross test two hypotheses. The first predicts that the health gap by educational level increases with age across adulthood. The second predicts that health differences across education levels have been growing over the decades. Both hypotheses are supported using a nationwide longitudinal sample of US adults.

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                                                            • Ross, Catherine E., and Chia-Ling Wu. 1996. Education, age, and cumulative advantage in health. Journal of Health and Social Behavior 37:104–120.

                                                              DOI: 10.2307/2137234Save Citation »Export Citation »E-mail Citation »

                                                              Ross and Wu address the question of how the education–health gap changes with age. They use data from three different surveys and find that the education–health gap increases with age. This supports the cumulative advantage perspective.

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                                                              Gender

                                                              The classic study of Kitagawa and Hauser 1973 (cited under Classic Works and General Overviews), reviewed above, found that educational differences in mortality were wider for US women than for men; that is, women seemed to benefit more from their education than did men. Since then, however, there has been ongoing debate regarding gender differences in the education–health and education–mortality relationships. Studies by McDonough, et al. 1999 and Zajacova 2006 find no difference in the education–mortality association by gender, but more recent work by Zajacova and Hummer 2009 and Montez, et al. 2009 exhibited somewhat wider education differences in mortality for US men compared to women. Internationally, Mackenbach, et al. 1999 also finds wider differences in mortality for men compared to women in the seven countries the authors examined. At the same time, Ross and Mirowsky 2010 documents a stronger education–health association for US women than men. Ross, et al. 2012 later concludes that high levels of education work to help equalize gender gaps in both health and mortality.

                                                              • Mackenbach, Johan P., Anton E. Kunst, Feikje Groenhof, et al. 1999. Socioeconomic inequalities in mortality among women and among men: An international study. American Journal of Public Health 89:1800–1806.

                                                                DOI: 10.2105/AJPH.89.12.1800Save Citation »Export Citation »E-mail Citation »

                                                                Mackenbach and colleagues examine total and cause-specific mortality by educational attainment among women and men in the United States and six European countries using data from 1980 and 1990. They find that men tend to have larger relative educational inequalities in total mortality and for some specific causes of death.

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                                                                • McDonough, Peggy, David R. Williams, James S. House, and Greg J. Duncan. 1999. Gender and the socioeconomic gradient in mortality. Journal of Health and Social Behavior 40.1: 17–31.

                                                                  DOI: 10.2307/2676376Save Citation »Export Citation »E-mail Citation »

                                                                  The authors challenge the finding that the association between socioeconomic status and mortality is weaker among US women. They find no gender differences in the relationship between educational attainment and mortality.

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                                                                  • Montez, Jennifer Karas, Mark D. Hayward, Dustin C. Brown, and Robert A. Hummer. 2009. Why is the educational gradient of mortality steeper for men? Journal of Gerontology: Social Sciences 64B.5: 625–634.

                                                                    DOI: 10.1093/geronb/gbp013Save Citation »Export Citation »E-mail Citation »

                                                                    Montez and colleagues ask why educational differences in mortality are greater for US men compared to women. They show that low-educated, unmarried men have particularly high mortality that is the result of their much higher levels of cigarette smoking compared to other population subgroups.

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                                                                    • Ross, Catherine E., Ryan K. Masters, and Robert A. Hummer. 2012. Education and the gender gaps in health and mortality. Demography 49.4: 1157–1183.

                                                                      DOI: 10.1007/s13524-012-0130-zSave Citation »Export Citation »E-mail Citation »

                                                                      Ross and colleagues show that the education–mortality association is modestly stronger for US men compared to women, but that the education association with health is stronger for women. Because women report worse health, but men’s mortality is higher, high education serves to close the gender gaps in both health and mortality.

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                                                                      • Ross, Catherine E., and John Mirowsky. 2010. Gender and the health benefits of education. Sociological Quarterly 51:1–19.

                                                                        DOI: 10.1111/j.1533-8525.2009.01164.xSave Citation »Export Citation »E-mail Citation »

                                                                        Ross and Mirowsky develop a theory that education improves health more for women than men, which they call resource substitution. The analysis provides support for their theory. As education level increases, physical impairment decreases more for women than for men. There is hardly any gender gap in health among people with college degrees.

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                                                                        • Zajacova, Anna. 2006. Education, gender, and mortality: Does schooling have the same effect on mortality for men and women in the US? Social Science and Medicine 63.8: 2176–2190.

                                                                          DOI: 10.1016/j.socscimed.2006.04.031Save Citation »Export Citation »E-mail Citation »

                                                                          Zajacova analyzes whether the impact of education on mortality differs by gender. She finds that education has a similar effect on mortality for men and women.

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                                                                          • Zajacova, Anna, and Robert A. Hummer. 2009. Gender differences in education effects on all-cause mortality for white and black adults in the United States. Social Science and Medicine 69.4: 529–537.

                                                                            DOI: 10.1016/j.socscimed.2009.06.028Save Citation »Export Citation »E-mail Citation »

                                                                            The authors reexamine gender differences in the association between education and mortality among US non-Hispanic blacks and whites. The results reveal a great deal of similarity in the education–mortality association for men and women. However, one notable exception is that mortality declines more steeply for white men than for white women at high levels of schooling.

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                                                                            Race and Ethnicity

                                                                            Does educational attainment affect health similarly or differently when comparing race or ethnic groups? This area of study is important because it indicates whether or not education is an effective determinant of health among different groups in society. Kimbro, et al. 2008 clearly shows that education is a more powerful determinant of health for US-born individuals than for foreign-born individuals, as well as for non-Hispanic whites compared to most minority groups. Earlier, Goldman, et al. 2006 showed weaker educational effects on health specific to the Mexican origin population in the United States compared to non-Hispanic whites. Similarly, Turra and Goldman 2007 showed smaller educational differences in mortality when comparing the US Hispanic population to non-Hispanic whites. And in a classic earlier paper on the topic, Schoendorf, et al. 1992 showed that black–white differences in infant mortality were much wider among college-educated mothers than among women who had low levels of education.

                                                                            • Goldman, Noreen, Rachel T. Kimbro, Cassio M. Turra, and Anne R. Pebley. 2006. Socioeconomic gradients in health for white and Mexican-origin populations. American Journal of Public Health 96.12: 2186–2193.

                                                                              DOI: 10.2105/AJPH.2005.062752Save Citation »Export Citation »E-mail Citation »

                                                                              The authors analyze educational differences in health outcomes and behaviors for white and Mexican-born adults, adolescents, and infants in the United States. They found that Mexican immigrants tend to have a weaker association between education and health outcomes than whites. Multiple reasons are suggested to explain the difference.

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                                                                              • Kimbro, Rachel T., Sharon Bzostek, Noreen Goldman, and German Rodriguez. 2008. Race, ethnicity, and the education gradient in health. Health Affairs 27.2: 361–372.

                                                                                DOI: 10.1377/hlthaff.27.2.361Save Citation »Export Citation »E-mail Citation »

                                                                                Using data from the 2000–2006 National Health Interview Survey, the authors find that education is a much more powerful determinant of health outcomes and behaviors for some racial and ethnic groups than others. Also, they find that educational differentials in health outcomes and behaviors for foreign-born groups are narrower than those for corresponding US-born groups.

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                                                                                • Schoendorf, Kenneth C., Carol J. R. Hogue, Joel C. Kleinman, and Diane Rowley. 1992. Mortality among infants of black as compared with white college-educated parents. New England Journal of Medicine 326.23: 1522–1526.

                                                                                  DOI: 10.1056/NEJM199206043262303Save Citation »Export Citation »E-mail Citation »

                                                                                  The authors find that black infants born to college-educated mothers have significantly higher mortality rates than white infants with college-educated mothers. Relative black–white differences in infant mortality were found to be much narrower among women with low levels of education.

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                                                                                  • Turra, Cassio M., and Noreen Goldman. 2007. Socioeconomic differences in mortality among U.S. adults: Insights into the Hispanic paradox. Journal of Gerontology 62B.3: S184–S192.

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                                                                                    Turra and Goldman examine mortality differences by education and income for Hispanics and non-Hispanic whites. Education differences in mortality are narrower for Hispanics compared to whites because low-educated Hispanics have relatively low mortality rates.

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                                                                                    Trends in the Relationship between Education and Health Outcomes

                                                                                    Since the classic Kitagawa and Hauser mortality study using 1960 data, researchers have been particularly interested in documenting whether or not educational differences in US mortality were narrowing, stagnating, or widening. The answer to this question is particularly important because it provides insight into trends in health inequalities in US society. In a very well-cited study, Pappas, et al. 1993 documented substantially widening mortality differences by education between 1960 and 1985. Preston and Elo 1995 tempered those findings with a very careful analysis of data that showed widening educational differences in mortality for men, but not for women, over the same time period. More recently, studies by Masters, et al. 2012; Miech, et al. 2011; Meara, et al. 2008; and Jemal, et al. 2008 used different data sets and methods but arrived at a similar conclusion: educational differences in US adult mortality widened between the mid-1980s and the mid-2000s. Related work by Liu and Hummer 2008 and Dupre 2007 demonstrated that educational attainment is differentiating the overall health of the US population significantly more so in recent years compared to the 1970s and 1980s.

                                                                                    • Dupre, Matthew E. 2007. Educational differences in age-related patterns of disease: Reconsidering cumulative disadvantage and age-as-leveler. Journal of Health and Social Behavior 48.1: 1–15.

                                                                                      DOI: 10.1177/002214650704800101Save Citation »Export Citation »E-mail Citation »

                                                                                      Dupre examines cohort-based change in the relationship between educational attainment and patterns of chronic disease. He finds that educational attainment is more closely related to the presence of chronic diseases such as hypertension and diabetes among more recent birth cohorts of US adults compared to previous cohorts.

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                                                                                      • Jemal, Ahmedin, Michael J. Thun, Elizabeth E. Ward, S. Jane Henley, Vilma E. Cokkinides, and Taylor E. Murray. 2008. Mortality from leading causes by education and race in the United States, 2001. American Journal of Preventive Medicine 34.1: 1–8.

                                                                                        DOI: 10.1016/j.amepre.2007.09.017Save Citation »Export Citation »E-mail Citation »

                                                                                        Annual age-standardized death rates from 1993 to 2001 were calculated for non-Hispanic white and black adults by level of education, both for all-cause mortality and for leading causes of death. Mortality rates decreased significantly for highly educated men and women over the eight-year period, while the cause-specific rates for the less educated either increased or stayed the same.

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                                                                                        • Liu, Hui, and Robert A. Hummer. 2008. Are educational differences in U.S. self-rated health increasing? An examination by gender and race. Social Science and Medicine 67.11: 1898–1906.

                                                                                          DOI: 10.1016/j.socscimed.2008.09.021Save Citation »Export Citation »E-mail Citation »

                                                                                          Liu and Hummer show widening gaps in self-rated health by educational attainment in the United States between 1982 and 2003 for middle-aged and older adults, but slightly narrowing gaps among young adults.

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                                                                                          • Masters, Ryan K., Robert A. Hummer, and Daniel A. Powers. 2012. Educational differences in U.S. adult mortality: A cohort perspective. American Sociological Review 77.4: 548–572.

                                                                                            DOI: 10.1177/0003122412451019Save Citation »Export Citation »E-mail Citation »

                                                                                            The authors examine cohort differences in the relationship between educational attainment and US adult mortality for white and black men and women. Disparities in mortality risk by education widened between 1986 and 2006 across US birth cohorts, especially for heart disease and lung cancer. Disparities widened in particular for white men and women.

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                                                                                            • Meara, Ellen R., Seth Richards, and David M. Cutler. 2008. The gap gets bigger: Changes in mortality and life expectancy, by education, 1981–2000. Health Affairs 27.2: 350–360.

                                                                                              DOI: 10.1377/hlthaff.27.2.350Save Citation »Export Citation »E-mail Citation »

                                                                                              This paper documented trends in educational disparities in mortality among non-Hispanic blacks and whites over the 1980s and 1990s. They find that the educational gap in life expectancy increased by 30 percent across the time period, mostly due to the longevity gains made by better-educated groups.

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                                                                                              • Miech, Richard, Fred Pampel, Jinyoung Kim, and Richard G. Rogers. 2011. The enduring association between education and mortality: The role of widening and narrowing disparities. American Sociological Review 76.6: 913–934.

                                                                                                DOI: 10.1177/0003122411411276Save Citation »Export Citation »E-mail Citation »

                                                                                                The findings reveal significant changes in educational disparities in mortality for detailed causes of death between 1989 and 2007. Most causes of death with increasing mortality rates displayed widening educational disparities. Growing educational disparities since 1999 have caused a 25 percent increase in the total educational disparity in adult mortality.

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                                                                                                • Pappas, Gregory, Susan Queen, Wilbur Hadden, and Gail Fisher. 1993. The increasing disparity in mortality between socioeconomic groups in the United States, 1960–1986. New England Journal of Medicine 329.2: 103–109.

                                                                                                  DOI: 10.1056/NEJM199307083290207Save Citation »Export Citation »E-mail Citation »

                                                                                                  This paper poses the question of whether all socioeconomic groups benefited from the decrease in total death rates in the United States from 1960 to 1986. Results show that educational disparities in mortality increased significantly between 1960 and 1986.

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                                                                                                  • Preston, Samuel H., and Irma T. Elo. 1995. Are education differentials in adult mortality increasing in the United States? Journal of Aging and Health 7.4: 476–496.

                                                                                                    DOI: 10.1177/089826439500700402Save Citation »Export Citation »E-mail Citation »

                                                                                                    Preston and Elo examine studies that compare educational mortality differentials from 1960 to 1980. Using a new data source, they evaluate the differentials from 1960 and find that educational inequalities increased for males but decreased for working-age females.

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                                                                                                    Education’s Influence on the Health of Others

                                                                                                    Education is not simply an individual resource. Alternatively, the educational level of individuals can influence the health and health behavior of other individuals, particularly within the same family. This section provides an overview of two sets of studies that show such spillover effects of education; one set focuses on how maternal education influences child health and the second set focuses on how the education of one spouse in a married couple influences the health and health behavior of the other spouse.

                                                                                                    Maternal Education and Child Health

                                                                                                    Caldwell 1986 provides a classic examination of how maternal education and empowerment, even in some very poor countries, works to reduce infant and child mortality rates in those countries. Desai and Alva 1998 provides a broader examination of the causal influence of maternal education on child health in twenty-two developing countries and report fairly weak causal effects of maternal education on infant health outcomes but stronger effects on child immunization. Singh and Kogan 2007 examines US trends in the relationship between maternal education and infant mortality over thirty-two years. They find that maternal education differences in infant mortality have remained very strong in the US context: infants with highly educated mothers are less likely to die during their first year of life compared to infants with less educated mothers. And Currie and Moretti 2003 show that women with higher levels of education exhibit healthier behaviors during pregnancy than women with lower levels of education; such maternal behaviors have important impacts on infant health.

                                                                                                    • Caldwell, John C. 1986. Routes to low mortality in poor countries. Population and Development Review 12.2: 171–220.

                                                                                                      DOI: 10.2307/1973108Save Citation »Export Citation »E-mail Citation »

                                                                                                      In this classic paper, Caldwell investigates why certain poor countries have lower infant and child mortality rates than other poor countries. Poor countries where women have low levels of education and where women’s status is low tend to have higher infant and child mortality rates; poor countries where women’s educational level and status are higher exhibit lower mortality rates.

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                                                                                                      • Currie, Janet, and Enrico Moretti. 2003. Mother’s education and the intergenerational transmission of human capital: Evidence from college openings. Quarterly Journal of Economics 118.14: 1495–1532.

                                                                                                        DOI: 10.1162/003355303322552856Save Citation »Export Citation »E-mail Citation »

                                                                                                        Birth certificate data from 1970 to 1999 are used to analyze the effect of maternal education on pregnancy health behavior and birth outcomes. Currie and Moretti find that higher maternal education improves infant health. High education also increases the probability that mothers are married and utilize prenatal care, and decreases the probability of smoking during pregnancy.

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                                                                                                        • Desai, Sondale, and Soumya Alva. 1998. Maternal education and child health: Is there a strong causal relationship? Demography 35.1: 71–81.

                                                                                                          DOI: 10.2307/3004028Save Citation »Export Citation »E-mail Citation »

                                                                                                          Using data from twenty-two developing countries, the authors examine the effect of maternal education on infant mortality, child’s height-for-age, and immunization status. Findings show that maternal education affects infant mortality and height-for-age in only a few countries once adequate controls are included in models, but it affects immunization status in eleven countries.

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                                                                                                          • Singh, Gopal K., and Michael D. Kogan. 2007. Persistent socioeconomic disparities in infant, neonatal, and postneonatal mortality rates in the United States, 1969–2001. Pediatrics 119:e928–e939.

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                                                                                                            The authors use national linked infant birth and death data to examine inequalities in infant, neonatal, and postneonatal mortality rates by maternal education. They find that even though infant mortality rates have decreased, socioeconomic disparities have increased over time. The risk of infant mortality is higher among less educated mothers throughout the study.

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                                                                                                            Spousal Education and Health

                                                                                                            European sociologists, demographers, and epidemiologists have been most active in examining how the education of one spouse influences the health and mortality risk of the other spouse. This stream of research largely shows that more highly educated spouses exhibit positive effects on the health and health behavior of the other spouse, even when controlling for individual-level education. Although Jaffe, et al. 2005 finds no impact of husbands’ education on wives’ mortality in Israel, they show significant impact of wives’ education on husbands’ mortality. Egeland, et al. 2002 shows strong spousal effects of education on husbands’ coronary heart disease mortality in Norway. Later, Monden, et al. 2003 and Kravadal 2008 used data from the Netherlands and Norway, respectively, to show that both wives’ and husbands’ education have important impacts on each other’s health. And in perhaps the most sophisticated research design in this area to date, Skalická and Kunst 2008 show that wives’ education is the most important socioeconomic predictor for husbands’ mortality risk in Norway, while husbands’ income and occupation are stronger socioeconomic predictors of wives’ mortality risk.

                                                                                                            • Egeland, Grace M., Aage Tverdal, Haakon E. Meyer, and Randi Selmer. 2002. A man’s heart and a wife’s education: 12-year coronary heart disease mortality follow-up in Norwegian men. International Journal of Epidemiology 31.4: 799–805.

                                                                                                              DOI: 10.1093/ije/31.4.799Save Citation »Export Citation »E-mail Citation »

                                                                                                              This article tests whether wives’ education is associated with men’s risk of coronary heart disease. The data are from married Norwegian men recruited for cardiovascular disease screenings from 1977 to 1983. The findings show that wives’ higher education inversely affects men’s coronary heart disease risk factors.

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                                                                                                              • Jaffe, D. H., Z. Eisenbach, Y. D. Neumark, and O. Manor. 2005. Does one’s own and one’s spouse’s education affect overall and cause-specific mortality in the elderly? International Journal of Epidemiology 34:1409–1416.

                                                                                                                DOI: 10.1093/ije/dyi185Save Citation »Export Citation »E-mail Citation »

                                                                                                                Israeli census-based data are used to examine how educational level affects elderly men and women and their spouses. The effect of education on individual and spousal mortality varies by gender and cause of death. Men with less educated wives have a higher risk of cardiovascular disease mortality, while women tend to be less affected by husbands’ education.

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                                                                                                                • Kravadal, ∅ystein. 2008. A broader perspective on education and mortality: Are we influenced by other people’s education? Social Science and Medicine 66:620–636.

                                                                                                                  DOI: 10.1016/j.socscimed.2007.10.009Save Citation »Export Citation »E-mail Citation »

                                                                                                                  Kravadal examines how family members’ education affects individual health in Norwegian men and women. Among familial relations, a spouse’s education has the greatest impact on an individual’s health, though the individual’s own educational level is very important as well.

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                                                                                                                  • Monden, Christiaan W. S., Frank van Lenthe, Nan Dirk de Graff, and Gerbert Kraaykamp. 2003. Partner’s own education: Does who you live with matter for self-assessed health, smoking and excessive alcohol consumption? Social Science and Medicine 57.10: 1902–1912.

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                                                                                                                    The influence of individual and partner’s education on self-assessed health, excessive alcohol use, and smoking is studied using data from forty thousand Dutch adults. Partner’s education affects individual self-assessed health and smoking for both women and men when controlling for individual’s own education.

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                                                                                                                    • Skalická, Věra, and Anton E. Kunst. 2008. Effects of spouse’s socioeconomic characteristics on mortality among men and women in a Norwegian longitudinal study. Social Science and Medicine 66.9: 2035–2047.

                                                                                                                      DOI: 10.1016/j.socscimed.2008.01.020Save Citation »Export Citation »E-mail Citation »

                                                                                                                      The authors examine the impact of a spouse’s education, income, and occupation on cause-specific mortality in Norwegian men and women. They find that in men, wife’s education is the strongest predictor of mortality risk. In women, all three husband’s socioeconomic characteristics have an impact on cause-specific mortality, but income and occupation are stronger predictors.

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                                                                                                                      International Comparative Studies of Education and Health Outcomes

                                                                                                                      International comparative studies in the education and health area are important because they indicate the extent to which health inequalities by educational level differ across national contexts. The comparative study of smoking Pampel and Denney 2011, for example, shows wider differences in cigarette smoking by educational level among wealthier countries. Similarly, Pampel, et al. 2012 shows that educational differences in overweight and obesity are larger in higher income countries. Kunst and Mackenbach 1994 provided the earliest impact paper in this area by showing wider educational differences in men’s premature (aged 35–64) mortality in the United States, France, and Italy and smaller educational differences in Sweden, Denmark, Norway, and the Netherlands. Elo, et al. 2006, however, showed wider educational differences among Finnish adults than among American adults. Further, Avenando, et al. 2010 showed that only a small portion of the overall lower life expectancy in the United States compared to most western European countries is due to the wider educational differences in mortality in the United States. Finally, two massive studies by Huisman, et al. 2004 and Huisman, et al. 2005 assess cross-national differences in educational differences in mortality for both men and women across a range of European countries.

                                                                                                                      • Avenando, Mauricio, Renske Kok, Maria Glymour, et al. with support from members of the Eurothine Consortium. 2010. Do Americans have higher mortality than Europeans at all levels of the education distribution? A comparison of the United States and 14 European countries. In International differences in mortality at older ages: Dimensions and sources. Edited by Eileen M. Crimmins, Samuel H. Preston, and Barney Cohen, 313–332. Washington, DC: National Academies Press.

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                                                                                                                        Avenando and colleagues assess whether the United States has an overall lower life expectancy than many western European countries because educational differences in mortality are larger in the United States. They find that only a small portion of lower US life expectancy is attributable to excess US mortality at low levels of education.

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                                                                                                                        • Elo, Irma T., Pekka Martikainen, and Kirsten P. Smith. 2006. Socioeconomic differentials in mortality in Finland and the United States: The role of education and income. European Journal of Population 22.2: 179–203.

                                                                                                                          DOI: 10.1007/s10680-006-0003-5Save Citation »Export Citation »E-mail Citation »

                                                                                                                          The authors detail cause-specific mortality disparities by education and income for Finnish and American adults. In both countries, mortality decreases with increasing educational attainment. Finnish men have the most pronounced education–mortality gradient.

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                                                                                                                          • Huisman, M., A. E. Kunst, O. Andersen, et al. 2004. Socioeconomic inequalities in mortality among elderly people in 11 European populations. Journal of Epidemiology Community Health 58.6: 468–475.

                                                                                                                            DOI: 10.1136/jech.2003.010496Save Citation »Export Citation »E-mail Citation »

                                                                                                                            The authors study mortality inequalities by education in eleven European populations. They find that in the pooled population, educational inequalities in mortality decrease with age but persist into the nineties. But in some populations, the educational differences do not decrease with age. They argue that educational differences in mortality are an important European health problem.

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                                                                                                                            • Huisman, Martijn, Anton E. Kunst, Mathhias Bopp, et al. 2005. Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet 365.9458: 493–500.

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                                                                                                                              This article examines mortality disparities by education in middle-aged and elderly people in eight European populations. Mortality disparities by educational attainment are at their peak among adults seventy-five and older. While the overall pattern of education differences in mortality are similar across countries, cause of death patterns that account for the differences differ.

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                                                                                                                              • Kunst, Anton E., and Johan P. Mackenbach. 1994. The size of mortality differences associated with educational level in nine industrialized countries. American Journal of Public Health 84.6: 932–937.

                                                                                                                                DOI: 10.2105/AJPH.84.6.932Save Citation »Export Citation »E-mail Citation »

                                                                                                                                Kunst and Mackenbach detail educational differences in mortality for men aged thirty-five to sixty-four in nine countries. The United States and France have large educational inequalities in mortality, while education differences in mortality are much smaller in the Netherlands, Sweden, Denmark, and Norway. Social and economic policies across countries may help explain the differences.

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                                                                                                                                • Pampel, Fred C., and Justin T. Denney. 2011. Cross-national sources of health inequality: Education and tobacco use in the world health survey. Demography 48.2: 653–674.

                                                                                                                                  DOI: 10.1007/s13524-011-0027-2Save Citation »Export Citation »E-mail Citation »

                                                                                                                                  Pampel and Denney examine World Health Survey data for men and women from fifty countries and find that when national income and cigarette diffusion increase, educational disparities in cigarette smoking are wider, especially among men and younger adults.

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                                                                                                                                  • Pampel, Fred C., Justin T. Denney, and Patrick M. Krueger. 2012. Obesity, SES, and economic development: A test of the reversal hypothesis. Social Science and Medicine 74.7: 1073–1081.

                                                                                                                                    DOI: 10.1016/j.socscimed.2011.12.028Save Citation »Export Citation »E-mail Citation »

                                                                                                                                    By using World Health Survey data from sixty-seven countries, the authors show that education differentials in both overweight and obesity are larger in nations with higher levels of economic development. Levels of overweight and obesity are much higher among low educated than high educated persons in countries with high levels of economic development.

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                                                                                                                                    Education and Health Outcomes: Issues of Causality

                                                                                                                                    Perhaps the most difficult and policy-relevant scientific issue in the area of education and health surrounds the question of causality: is education causally related to improved health, or is the strong education–health association actually due to other confounding factors? Kawachi, et al. 2010 provide an excellent summary of the debate in this area. The studies by Behrman, et al. 2011; Fujiwara and Kawachi 2009; and Gottfredson 2004 put forward evidence that education may not be causally related to some health outcomes in some contexts. But the studies by Lleras-Muney 2005; Glied and Lleras-Muney 2008; Link, et al. 2008; and Phelan, et al. 2004 show quite strong causal influences of education on health outcomes. The causality debate on the education–health association will surely continue for quite some time because it is so important from both the scientific and policy perspectives.

                                                                                                                                    • Behrman, Jere R., Hans-Peter Kohler, Vibeke Myrup Jensen, et al. 2011. Does more schooling reduce hospitalization and delay mortality? New evidence based on Danish twins. Demography 48:1347–1375.

                                                                                                                                      DOI: 10.1007/s13524-011-0052-1Save Citation »Export Citation »E-mail Citation »

                                                                                                                                      Using data from a very unique data set of Danish twins, the authors investigate the relationship between education, risk of hospitalization, and mortality to see if there are causal effects. They find that there are negative associations between mortality, hospitalization, and education, but they find little evidence of causal effects.

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                                                                                                                                      • Fujiwara, Takeo, and Ichiro Kawachi. 2009. Is education causally related to better health? A twin fixed-effect study in the USA. International Journal of Epidemiology 38:1310–1322.

                                                                                                                                        DOI: 10.1093/ije/dyp226Save Citation »Export Citation »E-mail Citation »

                                                                                                                                        Fujiwara and Kawachi use a twin fixed-effect approach to identify the causal effects of education on health and health behavior. They find that some associations between education and health outcomes and behaviors do not show causal relationships, while in other cases, the associations do appear to be causal.

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                                                                                                                                        • Glied, Sherry, and Adriana Lleras-Muney. 2008. Technological innovation and inequality in health. Demography 45.3: 741–761.

                                                                                                                                          DOI: 10.1353/dem.0.0017Save Citation »Export Citation »E-mail Citation »

                                                                                                                                          The authors hypothesize that the strengthening effect of education on health is because more educated people are the first to use technological advancements that improve health. Findings show that more highly educated people have a greater chance of surviving diseases that are characterized by recent technological improvements in treatment.

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                                                                                                                                          • Gottfredson, Linda S. 2004. Intelligence: Is it the epidemiologist’s elusive “fundamental cause” of social class inequalities in health. Journal of Personality and Social Psychology 86.1: 174–199.

                                                                                                                                            DOI: 10.1037/0022-3514.86.1.174Save Citation »Export Citation »E-mail Citation »

                                                                                                                                            Gottfredson argues that inequalities in health may actually be due to differences in intelligence instead of material disadvantages, like lower education and less access to resources, or the psychosocial factors that accompany lower socioeconomic status.

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                                                                                                                                            • Kawachi, Ichiro, Nancy E. Adler, and William H. Dow. 2010. Money, schooling, and health: Mechanisms and causal evidence. Annals of the New York Academy of Sciences 1186.1: 56–68.

                                                                                                                                              DOI: 10.1111/j.1749-6632.2009.05340.xSave Citation »Export Citation »E-mail Citation »

                                                                                                                                              Kawachi and colleagues review literature on whether or not education and income are causally related to health outcomes. They conclude that there is enough evidence to suggest that education is causally related to improvements in health. They note, however, that much remains unknown regarding this question of causality, and they suggest avenues for further inquiry.

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                                                                                                                                              • Link, Bruce G., Jo C. Phelan, Richard Miech, and Emily Leckman Westin. 2008. The resources that matter: Fundamental causes of health disparities and the challenge of intelligence. Journal of Health and Social Behavior 49.1: 72–91.

                                                                                                                                                DOI: 10.1177/002214650804900106Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                The authors address Gottfriedson’s claim that intelligence accounts for the association between education and health. By using data sets that measure intelligence, education, and health, they find little evidence that intelligence has a direct effect on health when education is controlled, and that the impact of education does not change when intelligence is controlled.

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                                                                                                                                                • Lleras-Muney, Adriana. 2005. The relationship between education and adult mortality in the United States. Review of Economic Studies 72.1: 189–221.

                                                                                                                                                  DOI: 10.1111/0034-6527.00329Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                  Lleras-Muney conducts an innovative analysis of US census data to assess educational attainment’s causal effects on adult mortality. She finds that education has a causal impact on mortality and that the effect is perhaps larger than what was previously suggested in related literature.

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                                                                                                                                                  • Phelan, Jo C., Bruce G. Link, Ana Diez-Roux, Ichiro Kawachi, and Bruce Levin. 2004. “Fundamental causes” of social inequalities in mortality: A test of the theory. Journal of Health and Social Behavior 45.3: 265–285.

                                                                                                                                                    DOI: 10.1177/002214650404500303Save Citation »Export Citation »E-mail Citation »

                                                                                                                                                    The authors test the hypothesis that education will be more weakly associated with mortality for less preventable causes of death than for more preventable ones. Their hypothesis is supported, providing evidence for education as a causal factor related to US mortality risk.

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