Introduction
Is education generally associated with good health? There is a growing body of research that has been exploring the influence of education on health. Even in highly developed countries like the United States, it has been observed that adults with lower educational attainment suffer from poor health when compared to other populations [
36]. This pattern is attributed to the large health inequalities brought about by education. A clear understanding of the health benefits of education can therefore serve as the key to reducing health disparities and improving the well-being of future populations. Despite the growing attention, research in the education–health area does not offer definitive answers to some critical questions. Part of the reason is the fact that the two phenomena are interlinked through life spans within and across generations of populations [
36], thereby involving a larger social context within which the association is embedded. To some extent, research has also not considered the variances in the education–health relationship through the course of life or across birth cohorts [
20], or if there is causality in the same. There is therefore a growing need for new directions in education–health research.
The avenues through which education affects health are complex and interwoven. For one, at the very outset, the distribution and content of education changes over time [
20]. Second, the relationship between the mediators and health may change over time, as healthcare becomes more expensive and/or industries become either more, or less hazardous. Third, some research has documented that even relative changes in socioeconomic status (SES) can affect health, and thus changes in the distribution of education implies potential changes in the relationship between education and health. The relative index of inequality summarizes the magnitude of SES as a source of inequalities in health [
11,
21,
27,
29]. Fourth, changes in the distribution of health and mortality imply that the paths to poor health may have changed, thereby affecting the association with education.
Research has proposed that the relationship between education and health is attributable to three general classes of mediators: economic; social, psychological, and interpersonal; and behavioral health [
31]. Economic variables such as income and occupation mediate the relationship between education and health by controlling and determining access to acute and preventive medical care [
1,
2,
19]. Social, psychological, and interpersonal resources allow people with different levels of education to access coping resources and strategies [
10,
34], social support [
5,
22], and problem-solving and cognitive abilities to handle ill-health consequences such as stress [
16]. Healthy behaviors enable educated individuals to recognize symptoms of ill health in a timely manner and seek appropriate medical help [
14,
35].
While the positive association between education and health has been established, the explanations for this association are not [
31]. People who are well educated experience better health as reflected in the high levels of self-reported health and low levels of morbidity, mortality, and disability. By extension, low educational attainment is associated with self-reported poor health, shorter life expectancy, and shorter survival when sick. Prior research has suggested that the association between education and health is a complicated one, with a range of potential indicators that include (but are not limited to) interrelationships between demographic and family background indicators [
8] - effects of poor health in childhood, greater resources associated with higher levels of education, appreciation of good health behaviors, and access to social networks. Some evidence suggests that education is strongly linked to health determinants such as preventative care [
9]. Education helps promote and sustain healthy lifestyles and positive choices, nurture relationships, and enhance personal, family, and community well-being. However, there are some adverse effects of education too [
9]. Education may result in increased attention to preventive care, which, though beneficial in the long term, raises healthcare costs in the short term. Some studies have found a positive association between education and some forms of illicit drug and alcohol use. Finally, although education is said to be effective for depression, it has been found to have much less substantial impact in general happiness or well-being [
9].
On a universal scale, it has been accepted that several social factors outside the realm of healthcare influence the health outcomes [
37]. The differences in morbidity, mortality and risk factors in research, conducted within and between countries, are impacted by the characteristics of the physical and social environment, and the structural policies that shape them [
37]. Among the developed countries, the United States reflects huge disparities in educational status over the last few decades [
15,
24]. Life expectancy, while increasing for all others, has decreased among white Americans without a high school diploma - particularly women [
25,
26,
32]. The sources of inequality in educational opportunities for American youth include the neighborhood they live in, the color of their skin, the schools they attend, and the financial resources of their families. In addition, the adverse trends in mortality and morbidity brought on by opioids resulting in suicides and overdoses (referred to as deaths of despair) exacerbated the disparities [
21]. Collectively, these trends have brought about large economic and social inequalities in society such that the people with more education are likely to have more health literacy, live longer, experience better health outcomes, practice health promoting behaviors, and obtain timely health checkups [
21,
17].
Education enables people to develop a broad range of skills and traits (including cognitive and problem-solving abilities, learned effectiveness, and personal control) that predispose them towards improved health outcomes [
23], ultimately contributing to human capital. Over the years, education has paved the way for a country’s financial security, stable employment, and social success [
3]. Countries that adopt policies for the improvement of education also reap the benefits of healthy behavior such as reducing the population rates of smoking and obesity. Reducing health disparities and improving citizen health can be accomplished only through a thorough understanding of the health benefits conferred by education.
There is an iterative relationship between education and health. While poor education is associated with poor health due to income, resources, healthy behaviors, healthy neighborhood, and other socioeconomic factors, poor health, in turn, is associated with educational setbacks and interference with schooling through difficulties with learning disabilities, absenteeism, or cognitive disorders [
30]. Education is therefore considered an important social determinant of health. The influence of national education on health works through a variety of mechanisms. Generally, education shows a relationship with self-rated health, and thus those with the highest education may have the best health [
30]. Also, health-risk behaviors seem to be reduced by higher expenditure into the publicly funded education system [
18], and those with good education are likely to have better knowledge of diseases [
33]. In general, the education–health gradients for individuals have been growing over time [
38].
To inform future education and health policies effectively, one needs to observe and analyze the opportunities that education generates during the early life span of individuals. This necessitates the adoption of some fundamental premises in research. Research must go beyond pure educational attainment and consider the associated effects preceding and succeeding such attainment. Research should consider the variations brought about by the education–health association across place and time, including the drivers that influence such variations [
36].
In the current research, we analyze the association between education and health indicators for various countries using empirical data from reliable sources such as the Organization for Economic Cooperation and Development (OECD) and World Bank. While many studies explore the relationship between education and health at a conceptual level, we deploy an empirical approach in investigating the patterns and relationships between the two sets of indicators. In addition, for the educational indicators, we not only incorporate the level of educational attainment, but also look at the potential socioeconomic benefits, such as enrollment rates (in each sector of educational level) and school life expectancy (at each educational level). We investigate the influences of educational indicators on national health indicators of infant mortality, child vaccinations, life expectancy at birth, premature mortality arising from lack of educational attainment, employment and training, and the level of national health expenditure. Our research question is:
What are some key influencers/drivers in the education-health relationship at a country level?
The current study is important because policy makers have an increasing concern on national health issues and on policies that support it. The effect of education is at the root level—creating better overall self-awareness on personal health and making healthcare more accessible. The paper is organized as follows: Section 2 discusses the background for the research. Section 3 discusses the research method; Section 4 offers the analysis and results; Section 5 provides a synthesis of the results and offers an integrated discussion; Section 6 contains the scope and limitations of the research; Section 7 offers conclusions with implications and directions for future research.
Background
Research has traditionally drawn from three broad theoretical perspectives in conceptualizing the relationship between education and health. The majority of research over the past two decades has been grounded in the
Fundamental Cause Theory (FCT) [
28], which posits that factors such as education are fundamental social causes of health inequalities because they determine access to resources (such as income, safe neighborhoods, or healthier lifestyles) that can assist in protecting or enhancing health [
36]. Some of the key social resources that contribute to socioeconomic status include education (knowledge), money, power, prestige, and social connections. As some of these undergo change, they will be associated with differentials in the health status of the population [
12].
Education has also been conceptualized using the
Human Capital Theory (HCT) that views it as a return on investment in the form of increased productivity [
4]. Education improves knowledge, skills, reasoning, effectiveness, and a broad range of other abilities that can be applied to improving health. The third approach - the
signaling or credentialing perspective [
6] - is adopted to address the large discontinuities in health at 12 and 16 years of schooling, which are typically associated with the receipt of a high school diploma and a college degree, respectively. This perspective considers the earned credentials of a person as a potential source that warrants social and economic returns. All these theoretical perspectives postulate a strong association between education and health and identify mechanisms through which education influences health. While the HCT proposes the mechanisms as embodied skills and abilities, FCT emphasizes the dynamism and flexibility of mechanisms, and the credentialing perspective proposes educational attainment through social responses. It needs to be stated, however, that all these approaches focus on education solely in terms of attainment, without emphasizing other institutional factors such as quality or type of education that may independently influence health. Additionally, while these approaches highlight the individual factors (individual attainment, attainment effects, and mechanisms), they do not give much emphasis to the social context in which education and health processes are embedded.
In the current research while we acknowledge the tenets of these theoretical perspectives, we incorporate the social mechanisms in education such as level of education, skills and abilities brought about by enrollment, school life expectancy, and the potential loss brought about by premature mortality. In this manner, we highlight the relevance of the social context in which the education and health domains are situated. We also study the dynamism of the mechanisms over countries and over time and incorporate the influences that precede and succeed educational attainment.
Discussion
Our results reveal how interlinked education and health can be. We show how a country can improve its health scenario by focusing on appropriate indicators of education. Countries with higher education levels are more likely to have better national health conditions. Among the adult education levels, tertiary education is the most critical indicator influencing healthcare in terms of infant mortality, life expectancy, child vaccination rates, and enrollment rates. Our results emphasize the role that education plays in the potential years of life lost, which is a measure that represents the average years a person would have lived had he/she not died prematurely. In addition to mortality rate, an economy needs to consider this indicator as a measure of health quality.
Other educational indicators that are major drivers of health include school life expectancy, particularly at the tertiary level. In order to improve the school life expectancy of the population, governments should control the number of youths ending up unemployed, dropping out of school, and without skills or training (the NEET rate). Education allows people to gain skills/abilities and knowledge on general health, enhancing their awareness of healthy behaviors and preventive care. By targeting promotions and campaigns that emphasize the importance of skills and employment, governments can reduce the NEET rates. And, by reducing the NEET rates, governments have the potential to address a broad array of vulnerabilities among youth, ranging from unemployment, early school dropouts, and labor market discouragement, which are all social issues that warrant attention in a growing economy.
We also bring to light the health disparities across countries and suggest implications for governments to target educational interventions that can reduce inequalities and improve health, at a macro level. The health effects of education are at the grass roots level - creating better overall self-awareness on personal health and making healthcare more accessible.
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