The relationship of education — higher or lower — on health is a very complex topic. —Julia Holmes, Analytics Studies Branch of the National Center for Health Statistics in the CDC
POCATELLO, Idaho — On a recent Saturday morning in the Holt Arena, wave after wave of the 2012 graduating class of Idaho State University collected their degrees, their individual specialties marked by tassels in lavender, black, drab, red, green. Regardless of the color dangling from the mortarboard, the big picture was the same, playing out at graduation ceremonies across the country: College graduation is an achievement that portends better jobs, more choices and, perhaps more surprisingly, potentially longer lives.
Education and longevity are soul mates, according to data from the Centers for Disease Control and Prevention. Its recent "Health, United States, 2011" report found men with a college degree gain on average 9.3 extra years compared to men who didn't graduate from high school. Women with degrees gain 8.6 years over women without high school diplomas.
The link between more education and better health outcomes has been noted repeatedly in studies.
"If medical researchers were to discover an elixir that could increase life expectancy, reduce the burden of illness, delay the consequences of aging, decrease risky health behavior and shrink disparities in health, we would celebrate such a remarkable discovery," said the lead-in to a CDC special topic report clear back in 2007. "Robust epidemiological evidence suggests that education is such an elixir."
Education, it turns out, is a uniquely powerful predictor of health, with more years of school adding up to increasingly better health. And while it's strongly correlated with income and occupation, evidence suggests that education has its greatest impact on health, consistently associated with lower death rates, while less schooling means earlier death.
It's a little harder to tease out exactly why it's the case. But experts agree that education acts on health amid a patchwork of relationships that include demographic and family backgrounds, poor health in childhood, the increased resources higher education brings, good health behaviors and a person's social network. In short, education is a health intervention.
"The relationship of education — higher or lower — on health is a very complex topic," Julia Holmes, acting manager of the Analytics Studies Branch of the National Center for Health Statistics in the CDC, told the Deseret News. "In general, those with lower levels of education are more likely to engage in unhealthy behaviors and those are obvious risk factors for low health and premature mortality."
Education, she noted, is a proxy measure for economic status. She and other experts agree that people with better educations are more apt to get jobs that pay well, opening the doors to better benefits like insurance that reduce barriers to seeing doctors, improve access to healthful food choices and safer conditions, and lead to jobs that are less likely to be dangerous. Among ills that are less likely with better education levels: depression and anxiety, smoking, heart disease, obesity, days lost from work for illness.
Health experts say literacy — the pure ability to read — makes the biggest difference.
If you want to reduce infant mortality in developing countries, said Dr. Ian Bennett, a family physician who teaches at the Perelman School of Medicine at the University of Pennsylvania, help the mothers get an education. "If you can keep the females in school even for a few extra grades, it improves health outcomes for their children, but also for the whole society."
Reading ability, he said flatly, is associated with living longer.
Some of the reasons are fairly intuitive, he noted. Many of the jobs that people with less schooling can get are more dangerous. Schooling betters job options. One is more likely to die on a construction site than in an office. Bennett said parents set the tone for academic achievement; those who drop out are more apt to have children who drop out. Parents who read to their children increase the likelihood a child will read well. Those who struggle in fourth grade are less likely to graduate from high school. Girls who read below grade level at age 11 have elevated risk of having a baby before 19. "Girls with above-average reading skills have almost no likelihood of having a baby themselves as a teenager." They are domino facts, each leading to the next outcome.
Literacy plays a role in how well you can not only navigate a healthcare system, but handle its tools. Not understanding the treatment makes a medication overdose more likely. But more than that, "the biggest problem with not going far in school is having the bundled disadvantaged risk factors for having poor health," Bennett said, such as more substance abuse, smoking, poverty, increased risk of depression and less likelihood of accessing effective treatments.
People with better educations are more able to "understand the language that the healthcare system uses," said Dr. Richard Safeer, medical director of Johns Hopkins HealthCare. "They are more likely to be able to read the information that's available on the Internet and in the press — whatever form of communication is conveying a health message."
By the number
He said better education makes it easier to understand numbers. Numbers tell the story of a blood pressure that's too high, of cholesterol run amok. Medicine is about numbers — how many tablets and teaspoons, which hours and what temperatures. "There's a huge problem with people not understanding the label on their prescription bottle. Many people with poor literacy skills don't know how to translate the information on the label to what they do every day with it," he said.
What better-educated people may take for granted is not understandable to others, he said. Someone who has not graduated from high school may not have learned how to apply certain learned skills.
It may not be a question of intelligence. Dr. Barry D. Weiss, professor of family and community medicine at the University of Arizona College of Medicine, said that "if you look at poorer families living in areas of cities where people are less apt to go to college, they are not inherently less intelligent. But they may not get the education." He graduated college and expects his children to do the same. But that's not necessarily the expectation in families that struggle financially.
Improving health outcomes is not as simple as going to the doctor. "Going to the doctor doesn't make you stop smoking," Weiss said, "but knowing what it does makes it easier."
Education levels also impact where people live. "I can go to the store and buy organic food. If I am living in a rural area of Los Angeles, I am not buying organic; I can hardly afford fresh fruits and vegetables. When you make less money, your diet is not as good. Then you are more apt to be overweight and have heart disease. A lot of factors are going on," Weiss said.
Still, the future is not written, Bennett said. People with less schooling can close some of the gap.
Safeer says most hospitals have outreach programs and sponsor presentations on health topics. They offer screening. Some have experts trained in health education, even health coaches. Pharmacists can answer questions about drugs. Doctors' offices may have staff with more time to answer questions or educate someone. That may not actually be a doctor's forte and he or she seldom has enough time.
Hospitals and insurance companies offer resources at no extra cost, though they admittedly skew to the better-educated because it requires being proactive to find those aids and because people with education are more apt to have insurance.
The efforts to improve health outcomes and education, though, reach well beyond health settings. Grocery stores in the East, for example, sometimes offer tours for those with specific health issues, such as diabetes, showing healthier foods or how to read labels, Safeer said. They hold clinics and screenings.
Education is crucial to well-being, like sanitation, sewers, vaccination, clean water, Bennett said. But adult education and literacy programs have been crunched by tight budgets.
Knowledge is more than power. It's potentially longer life. "It's never too late," said Virginia Freid, a CDC health specialist. "If we make educational materials and indicate how people can change unhealthy behaviors now, we can make a difference in the totality of their life trajectory. ... You have to see health as your issue and not just your health provider's issue."
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