Americans are living longer than they ever have. Since 1960, life expectancy at birth has increased by more than nine years. While this is a sign of great progress — and a cause for celebration in public health and medicine — these gains have not been shared across the population. People with low levels of education live shorter lives than those with more education, and the gap has been getting bigger.
Each year, 145,000 deaths could be avoided if adults who had not completed high school went on to earn a GED or high school diploma, according to our recent study published in the journal PLOS ONE. Remarkably, this number is on par with the number of deaths that could be prevented if all current smokers stopped smoking today. We find that another 110,000 deaths could be avoided if those who had some college went on to complete their bachelor’s degree.
What links education to health and mortality? People with more education have safer jobs, higher income and social status, greater access to health care, and social networks that are more supportive of health. Education also develops cognitive and problem-solving skills that enhance one’s ability to find and understand new information, effectively pursue healthy behaviors, and adhere to treatment regimens. For example, successful treatment of insulin-dependent diabetes is cognitively demanding, and more-educated individuals are better able to consistently monitor blood sugar and effectively titrate the insulin dose depending on blood sugar levels, time of day, food intake, and activity levels. Education is important because it works through numerous pathways to help individuals both avoid and manage disease.
Disparities in mortality across education levels have widened over time and may continue to grow in the future. While mortality rates have fallen rapidly among men and women with college degrees, they are stagnant or potentially increasing for those without a high school diploma.
Accordingly, the number of deaths associated with failing to graduate from high school has doubled over a 20-year period. These disparities have widened, in part, because people with more education have disproportionately quit smoking, avoided lighting up in the first place, and benefited from advances in the prevention and treatment of cardiovascular disease. As the science of risk factors evolves and new diagnostic procedures and treatments are developed, those at the top of the education hierarchy are generally the first to reap the benefits and reap most of them.
Our findings show that graduating from high school can be as important as quitting smoking for longevity. Targeting education in early life may be more effective than trying to change a multitude of habits and behaviors later in life. At this point, most people are aware of simple public health prescriptions to avoid smoking, illicit drugs, sedentary behavior, and the excess consumption of alcohol and high calorie foods. The message has been received.
The more educated, however, get more out of this information because they have the social, economic, and cognitive resources to put knowledge about risks to their health into practice. Moreover, policy makers who are reluctant to impose a ban or to tax unhealthy substances may be more supportive of efforts to promote education.
Passage of the Affordable Care Act is a major achievement for public health that has already increased access to health care and may have reduced costs. It will not likely, however, solve education-based inequalities in health. Educational disparities in mortality remain substantial even in high-income countries with universal health care. Indeed, education is linked to health through health behaviors and a host of social and economic factors that are little influenced by health care.
The data clearly show that staying in school is more than just a good idea. It can be a matter of life and death.
Therefore, the policy makers should adjust their thinking on both education and health care policy. The two are fundamentally interrelated, to the extent that health policy makers should promote more educational attainment, while educators should consider their impact on health care outcomes. We routinely tell kids to stay in school because they can get a better job. Perhaps we should also tell them that education will help them live longer.
Virginia Chang, MD, PhD is an associate professor at NYU College of Global Public Health and the Department of Population Health at NYU School of Medicine. Patrick Krueger, PhD is an assistant professor in the Department of Health and Behavioral Sciences at the University of Colorado Denver.