Education and Health: The work of Paula Braveman
By Austin Frakt
Education is related to health. Better educated people tend to be healthier. Why? The pathways from education to health are varied and complex, as explained by Paula Braveman, one of the speakers at our Princeton meeting.
The relationship between education and health is complicated. Education can affect health, but health can affect education too. Individuals in poor health at a young age may not be able to attend school or focus on school work as much as those in better health. Other factors from genetics to environment can affect both educational attainment and health.
The site for the RWJF Commission to Build a Healthier America includes a wealth of information on social determinants of health. Among its resources is an issue brief on the association between education and health, co-authored by Paula Braveman.
As the issue brief explains, there are reasons to think education causally affects health through at least three potential pathways.
Knowledge and behaviors
The first pathway traces the chain from educational attainment, to health literacy, to health behaviors, and finally health outcomes. Education gives people the cognitive skills and knowledge to make better decisions about the options and behaviors that in turn, affect their health
Education effectively increases “health literacy,” which is correlated with better health outcomes; people with higher education are less likely to engage in unhealthy behaviors, like smoking, and more likely to engage in health-promoting behaviors. Some of these health promoting behaviors, like living in a more expensive neighborhood that has better air quality and access to healthy food, are facilitated by higher-paying jobs, which are affected by educational attainment in the next pathway.
Educational attainment affects work, and subsequently, health in many ways.
The first is work conditions. Lower educational attainment is associated with lower-paying jobs which often expose workers to these harmful working conditions.
Educational attainment also affects health through the resources that are available in the workplace. Workers with less education in lower-paying jobs are less likely to receive workplace benefits such as health insurance, paid sick leave, retirement benefits, and child and elder care resources, which can affect health outcomes.
Finally, educational attainment, can affect health through an income pathway. Increased educational attainment is closely associated with higher-wage jobs, and each additional year of schooling represents a significant increase in income. This differential in earning power can have huge impacts on health. Income and wealth allow people to pay for necessary health care, buy nutritious foods, live in safe areas, and access other resources that require financial investment.
This pathway shows how educational attainment can affect health through a matrix of social/psychological factors.
First, education is associated with a sense of control. Education facilitates the development of problem-solving skills which promote the understanding that one’s own actions influence health and life circumstances. An increased sense of control has been linked to healthy behaviors and better health outcomes, and may also open the door to employment opportunities by influencing job-seeking and performance.
Educational attainment also influences social standing. A higher “rank” in society, perceived both by the individuals themselves (“subjective social status”), and by society projected onto individuals, can influence health status. While educational attainment is closely associated with higher social standing and better health status, the mechanisms of this pathway are poorly understood.
Education can also affect social support which is linked to health. Higher educational attainment provides opportunities for developing relationships which can create stability in one’s life and career. Higher levels of social support are associated with better physical and mental health outcomes, in part by mitigating the negative health effects of stress and by providing access to resources that promote health, like better employment opportunities and housing.
These pathways are complex, interrelated, and multi-directional. While it is clear that education and health are closely related, more work is necessary to understand how.