Dynamic Changes in the Association Between Education and Health in the United States

Centennial Issue
Social determinants of health

Policy Points:

  • We reviewed some of the recent advances in education and health, arguing that attention to social contextual factors and the dynamics of social and institutional change provide critical insights into the ways in which the association is embedded in institutional contexts.
  • Based on our findings, we believe incorporating this perspective is fundamentally important to ameliorate current negative trends and inequality in Americans’ health and longevity.

Greater educational attainment is strongly associated with better health. Research has found this association across many world regions,1–4 social contexts,5–9 social groups,10–13 and historical periods.14–19 This association is not limited to one health outcome, but has been documented for an array of important measures, including self-rated health, biological risk, chronic conditions, mental health, mortality, and physical and cognitive functioning.20–27 The evidence has been consistent and voluminous, leading to the wide acceptance of this association as one of the leading social scientific “truths.”

Despite this enormous body of research, the question of how education influences health outcomes continues to generate a significant amount of research interest. In large part, researchers’ attention to this association reflects the growing recognition that the association is highly malleable. Research has shown that while more years of education are associated with better health, the magnitude of the association can vary widely, for example, across countries, within country administrative units such as states and provinces, across race/ethnic and gender groups, and across birth cohorts.8,10,12,28–30 These differences are leading researchers to consider how and why this malleability exists. Why and how do administrative units and social categories impact the association? Are there mechanisms at the institutional and individual levels (or combinations thereof) that can help us understand this dynamism? How is the education health association embedded in nested institutional contexts reflecting families, communities, institutions, and policies?31,32


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Hayward MD, Farina MP.Dynamic Changes in the Association Between Education and Health in the United States. Milbank Q. 2023;101(S1): 396-418.