Education Is Key Predictor of Health Outcomes

Ryan White, a 2011-12 California Endowment Health Journalism Fellow and a freelance writer, will be blogging for Reporting on Health during the 2012 National Health Journalism Fellowship July 22-26 in Los Angeles. Follow his and other posts about the fellowship on Twitter at #nhjf12.

If you could do one thing to ensure that you had a long, healthy life, what would you do?

That’s the question posed by Patrick Krueger, a sociologist at the University of Colorado, Denver, who studies the social factors determining our health. At first his answer doesn’t seem particularly promising.

“The one thing you should do to in order to ensure you have a long and healthy life is choose your parents wisely,” Krueger said, addressing participants of the 2012 National Health Journalism Fellowship. Parents, he explains, crucially influence so many of the social variables critical to an individual’s health: they pass down our genetic makeup, determine where we live as a child, get us through high school, and, if we’re lucky, help pay our way through college. “They can set us on a trajectory that takes us onto better health throughout the rest of our lives,” Krueger said.

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Even if we can’t yet prescreen our parental stock, Krueger’s point is well taken. Social conditions are powerful determinants of a person’s health. To illustrate the point, Krueger presented a chart comparing life expectancy with varying degrees of educational attainment. If you have less than a high school degree at 25, you can expect to live another 44 years, on average. Those with a graduate degree, however, can expect to live another 60 years, on average, according to Krueger.

“Social determinants can have a phenomenal impact on people’s live expectancy,” he said. It’s an observation that has the potential of reframing the way we look at health care in this country. While quality care can indeed improve a person’s health, doctors are often helpless to change the underlying conditions responsible for chronic ailments such as diabetes and asthma. “Physicians can’t write a prescription to move you into a better neighborhood, fix your bum marriage or give you a less taxing job,” Krueger notes.

According to Krueger, it’s not that personal decisions don’t matter when it comes to health; it’s just that an individual’s environment and socioeconomic status matter that much more when it comes to predicting health outcomes.

Krueger points to the current obesity epidemic and how higher education levels can lower risk. “As obesity becomes more prevalent, higher educated folks will be able to manage their environment better,” he said. A Ph.D. like himself might go out of his way to track down a salad for lunch, while those lower on the education spectrum might resort to one of the fast-food outlets ubiquitous in low-income neighborhoods.

Or take cholesterol, for example. A well-educated person is far more likely to visit their physician and start a regimen of cholesterol-lowering statins. “More highly educated individuals were some of the first adopters of some of those medical interventions,” Krueger said.

Social conditions are fundamental causes of disease, according to Krueger, and the lower you are on the socioeconomic ladder, the more likely you are to smoke, live a sedentary lifestyle, suffer from obesity, eat a poor diet, drive a dangerous car, lack adequate health care access — the list of risks stretches on.

But Krueger, with an eye toward the data, says higher educational achievement consistently mitigates the risks associated with environment. “You can die a whole lot of ways,” Krueger said. “Education can work to protect you against many of those.”

While the idea that good health means more than good health care is not new, Krueger’s insistence that education is perhaps the most important variable in determining a person’s health could push the health care conversation in a new direction.

“In the United States, when we talk about health policy we talk about health care, and we talk about doctors — maybe we get as far as thinking about neighborhoods,” Krueger said. “But to me the thing that always drives me nuts is that we spend so much money on health care and so little on education. But of all the social factors that are both modifiable and that we have a system in place that could actually address this relatively affordably, is education. And yet we keep cutting money from education.”

He takes his point ever further with a proposal that might begin to sound less radical over time. “Education is health policy,” he said. “The Department of Education and the Department of Health and Human Services should be put together.”

While that’s unlikely to happen anytime soon, Krueger’s analysis does suggest that the success of health care reform in this country might ultimately depend on the success of education reform and investment.

“Education is something that sticks with kids over their entire life,” Krueger said. “It pays dividends for years and it also does all the nice things we like when it comes to economic development, allowing folks to have opportunities for higher income, to move into nicer neighborhoods or to improve their own neighborhood.”

Image by Randen Pederson via Flickr.