Education
As in the case of income, educational level attained is strongly associated with lower illness and mortality rates
in industrialized country populations. Educational level attained by individuals is almost universally associated
with lower morbidity and mortality rates in epidemiological studies (Leigh, 1983; Ross, Mirowsky, 1999; Ross,
Wu, 1995). This relationship is consistent with the more generally cited relationship – perhaps the single
strongest empirical relationship in all of epidemiology – that overall socioeconomic status is a predictor of
lower morbidity and mortality for nearly all diagnoses, at all ages, both sexes and populations of different
ethnicity and immigration status (Smith, Hart, Hole, et al., 1998; Winkleby, Jatulis, Frank, Fortmann, 1992).
The explanation of the positive relationship between educational status and health clearly involves multiple
mechanisms. The most common understanding is that education itself, meaning the attainment of knowledge
enables the comprehension of the most widely recognized health risks (dealing e.g., with matters of diet,
environment, working conditions, stress and addictions) and the ability to secure the most timely and effective
health care. Even more generally, education is the basis for adaptation to opportunities and challenges in
economic and social areas of life.
Education is, of course, the most important prerequisite of higher skill and managerial levels of employment,
and is virtually essential to employment in professional and administrative positions in larger economic and
political organizations. Educational attainment level is, therefore, a strong factor in personal income and the
maintenance and advancement of careers in technological societies. In this era of rapid technological change
and globalization – leading to frequent restructuring of private firms and government organizations – relatively
high education levels permit more rapid transition to new jobs and the resumption of careers.
It should be kept in mind that educational level, a standard measure of ‘human capital’, has long been
understood as a significant source of economic growth. Of course, the extent of education in a population is
also financed from the wealth developed as a result of economic growth. This close linkage of education to the
economic growth process often means that once GDP per capita is used as a variable to account for increases in
life expectancy, no additional variables measuring the extent of education in a society is usually needed, even
though the level of education in a population may well make a substantial contribution to a population’s health.
This will be especially true in comparative (i.e., cross-sectional) analyses of industrialized countries.
Nevertheless, a variable that deals more directly with the extent to which the working population is highly
educated can often make an additional contribution to the explanation of life expectation among industrialized
societies. Such a variable, for example, is the proportion of the employed population who have achieved
tertiary education.
Especially intense are critiques from United States health policy specialists who contend that, in the case of
privately funded health care typically involving profit-making insurance companies, the cost of care bears little
relation to its quality or intensity, since much of private health care expenditure is either medically unnecessary
or occurs too late in life to significantly influence life expectancy (Bitton and Kahn, 2003; Woolhandler,
Himmelstein, 1997; 2002a; 2002b)
