I had a great time at the October 2018 IAPHS Conference learning about all the amazing population health research going on across the country, although it was sobering to think about the many serious health issues facing today’s American population. The session I organized highlighted educational differences in health, a particularly important topic given the diverging health and well-being of Americans across educational levels today.
A wide breadth of research has documented the strong, consistent relationship between educational attainment and a variety of physical, mental, and behavioral health outcomes. Put simply: more educated people lead healthier, longer lives. But the four presentations in this session showed that there is much we do not yet understand about the education-health relationship. The presentations challenged the dominant human capital paradigm used in education and health research. This perspective attributes the benefits of education to the knowledge and skills acquired in the classroom during school. While useful, this perspective may miss other important social processes.
For example, Anna Zajacova discussed the health prospects for the largest educational group of U.S. adults: those with some college experience but without a four-year degree. This group does not seem to have better health than those who finished high school but did not attend college, despite differences in exposure to schooling. This study, along with other research, provides strong evidence that the skills and knowledge gained during schooling are not sufficient to explain why highly educated people are healthier.
This session also demonstrated how a life course perspective can improve our understanding of how social determinants shape health. Jennifer Augustine reported that low-income mothers do not appear to receive any health benefits from gaining more education after the birth of a child, suggesting that intervention efforts should consider the context of education in addition to the highest attained level. We, as population health researchers, should consider more than just a person’s highest educational level. Matt Andersson and Renae Wilkinson highlighted the additional insight that can be gained from conceptualizing education as more than just attainment. They considered the health effects of educational experiences, operationalized as high school characteristics, finding that schooling may be influential, though perhaps not equally for all students. They reported that measures of high school quality were related to subsequent health, with stronger associations for those who from lower socioeconomic backgrounds.
Education is at the center of multiple life course processes and social contexts, and we cannot separate out these key relationships. Shawn Bauldry, presenting work in collaboration with Joseph Wolfe, Melissa Hardy, and Eliza Pavelko, highlighted the importance of both parents and children in shaping longevity. Population health researchers often consider socioeconomic background, but rarely examine how the socioeconomic status of children can influence parents’ health. This study showed strong associations for children’s educational attainment and mortality risk, providing compelling evidence that future studies can further examine.
Where do we go from here? It might seem like increasing levels of educational attainment, developing new technologies, or providing more health care would be useful for reducing educational differences in health. But we’ve been doing all of these things, and yet educational differences in health and longevity have been widening. Effective solutions might be more difficult, but the education-health relationship is also ripe for an interdisciplinary perspective. Many disciplines study education and health, and we can and do learn from one another. But we could also make greater progress through working collaboratively to develop theories, conceptual frameworks, and approaches that span disciplinary boundaries. It is my hope that conferences like IAPHS will go a long way in increasing our understanding and ultimately reducing differences in health.