What are Social Determinants of Health?
There are many factors that play a role in our overall health and wellness. Beyond individual characteristics such as genetics, there are also upstream factors known as Social Determinants of Health (SDOH). SDOH are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” One of these factors is education access and quality, and it plays an essential role in shaping health outcomes in the United States.
Education and Life Expectancy
Research shows that the more educated a person is, the longer they are likely to live. In fact, a 2020 Yale-led study found that even after accounting for other factors such as race and income, a person’s level of education is the best predictor of life expectancy. The study found that “each educational step obtained led to 1.37 fewer years of lost life expectancy.” Other research by the PNAS demonstrates that the one-third of Americans with a bachelor’s degree live longer and healthier lives than those without, and this gap continues to widen.
Education and Employment
It’s no secret that education and income are closely linked. Higher education leads to higher-paying jobs, and those with less education tend to earn less. This correlation between education and income has a significant impact on health outcomes.
Despite spending more on healthcare than any other country, income-health disparities in the United States are stark and persistent. Lower income is linked with poorer health, more chronic illness, and lower life expectancy. This phenomenon is known as the social gradient, “whereby people who are less advantaged in terms of socioeconomic position have worse health (and shorter lives) than those who are more advantaged.” This means that while the poorest people tend to have poorer health, even those in the middle-class experience health disparities relative to the rich.
Higher income comes with a greater ability to lead a healthy lifestyle. More disposable income makes it easier to buy healthy groceries, purchase a gym membership, and reside in a safe neighborhood. On the other hand, people with lower incomes face higher levels of food insecurity, have a harder time affording recreational activities, and are more likely to live in neighborhoods with higher levels of pollution and limited access to green space.
Along with these high-paying jobs come other resources that impact health outcomes. Individuals with higher levels of education “tend to have jobs that are more stable and flexible; provide good benefits, like paid leave, health insurance, and worksite wellness programs; and have fewer occupational hazards…[while] people with low incomes tend to have more restricted access to medical care, are more likely to be uninsured or underinsured, and face greater financial barriers to affording deductibles, copayments, and the costs of medicines and other health care expenses.”
A lack of health insurance is one of the largest barriers to healthcare access. Uninsured adults are less likely to utilize preventive services for chronic conditions, and the impacts extend to their children who are less likely to receive recommended immunizations and regular well-child visits.
Education and Lifestyle Factors
Greater education is linked with increased levels of happiness, and happiness is associated with a healthier life. For example, one study found that “emotional vitality—a sense of enthusiasm, of hopefulness, of engagement in life, and the ability to face life’s stresses with emotional balance—appears to reduce the risk of coronary heart disease.”
On the other hand, those with lower levels of education have a higher likelihood of experiencing stress, trauma, and discrimination. These stressful experiences can lead to a decreased immune response, higher risk of chronic disease, and accelerated aging. Chronic stress also increases the risk of mental health conditions and substance abuse. These dynamics create vicious cycles that are difficult to escape.
Those with higher education and socioeconomic status are more likely to engage in healthy behaviors, “including non-smoking, more physical activity, better nutrition, healthier alcohol consumption patterns, and greater levels of seatbelt use, preventive health care, and use of smoke detectors.” The more educated a person is, the higher their “cognitive resources,” which “include awareness of health benefits and risks and the ability to translate information and technology to improve health.” On the other hand, less-educated individuals may not have the knowledge and skills that are necessary to make informed decisions about their health. Furthermore, they are less likely to have a social network that supports healthy behaviors.
For those with lower education and income, “everyday life [can become] an all-consuming struggle, leaving little or no time or energy to adopt a healthier lifestyle…pursuing health requires a desire to preserve and invest in life; a marginalized existence can rob even a resilient person of this desire.” Combined with the fact that lower-income neighborhoods feature disproportionate advertisements promoting unhealthy behaviors such as junk food, alcohol and tobacco, these individuals face significant barriers when it comes to choosing healthy behaviors. “‘Choosing health’ may not be absolutely impossible in such an environment, but it certainly is far more difficult.”
Improving Education Access and Quality
Improving access to quality education is a solution that can help address these disparities in health outcomes. One way to do this is by focusing more attention on children. Unfortunately, children who experience poverty are more likely to experience poor health and less favorable mental and behavioral development. They are also less likely to experience healthy home environments and have positive role models.
However, the benefits of education at a young age can extend far into the future and “put children on a stronger path to success.” Many researchers agree that although socioeconomically disadvantaged children have some cards stacked against them, quality early childhood education can markedly improve their developmental outcomes. Investing in children can help to break generational cycles of social disadvantage and educational disparities. Healthy and educated children are more likely to become healthy adults, which in turn makes them more likely to raise healthy children.