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June 12, 2019

If you attended college, does that mean you'll live longer?

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    It's been demonstrated that health is "affected by lifestyle, genes, the environment, and the health system," but pinpointing the role education plays in better health is "tricky," Austin Frakt, a health economist, writes for the New York Times' "The Upshot."

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    Does education impact mortality?

    Frakt, who holds positions at the Department of Veterans AffairsBoston University's School of Public Health, and the Harvard T.H. Chan School of Public Health, notes that data suggest there's a relationship between education level and mortality.

    He cites CDC data that suggest mortality rates for people with some college education are more than 50% lower than mortality rates for people who never went to college. Similarly, Frakt notes that data from the United Kingdom suggest people who are more educated are less likely to have conditions like asthma, cardiovascular disease, or diabetes, and are also less likely to exhibit anxiety and depression.

    However, Frakt cautions that it's hard to draw conclusions from such data because "causality runs both ways." He explains, "People in poor health from a young age may be unable to pursue education as much as those with better health. On the other hand, a person who tends to focus on long-term outcomes may be motivated to develop healthier habits like regular exercise—even if blocked from a pursuit of higher education."

    Does education lead to better health?

    Nonetheless, Frakt writes that "some clever studies" offer a unique glimpse at "the causal effects of education" on health.

    He cites one study published in 2005 that analyzed the impact of state compulsory education laws on health. The laws, which were implemented between 1915 and 1939, resulted in some children attaining a higher level of education than they would have otherwise. According to the study, children who achieved an additional year of education by 1960 saw an increase in life expectancy by 1.7 years by age 35.

    Another study found that increased education was tied to lower odds of smoking and better overall health, showing that education, according to Frakt, "can reduce people's engagement in risky behaviors, perhaps because those behaviors could threaten the higher income that greater education typically confers."

    But "health behaviors can explain only a portion of the relationship between education and mortality," Frakt asserts. He notes that higher education is also linked with higher incomes, wealth, and social status—all things that are individually tied with better health.

    For example, Frakt cites a "landmark study" that was published in 1978 that found that high-ranking British civil servants had lower mortality rates from coronary heart disease than lower-ranking civil servants, who tended to weigh more, smoke more, and have higher blood pressure.

    Other factors, such as race and ethnicity also can have an effect on one's social status—and, as a result, health, Frakt writes.

    For instance, he notes black patients are more likely to live in areas with lower-quality hospitals and doctors and are less likely to receive preventive health care, which he notes may be a reason that population has "higher rates of mortality than white Americans, even after adjusting for income and education."

    However, he notes that's not necessarily the case for Hispanics. While they tend to be poorer on average than non-Hispanic white Americans, they also tend to be healthier, Frakt writes.

    So what does all of this mean? "Just as our health is affected by lifestyle, genes, the environment and the health system, education has a role, too." Frakt concludes. "We can't yet say exactly how much or exactly why" (Frakt, "The Upshot," New York Times, 6/4).

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