Using a variety of data sets from two countries, we examine possible explanations for the relationship between education and health behaviors, known as the education gradient. We show that income, health insurance, and family background can account for about 30 percent of the gradient. Knowledge and measures of cognitive ability explain an additional 30 percent. Social networks account for another 10 percent. Our proxies for discounting, risk aversion, or the value of future do not account for any of the education gradient, and neither do personality factors such as a sense of control of oneself or over one's life.In 1990, a 25 year-old male college graduate could expect to live another 54 years. A high school dropout of the same age could expect to live 8 years fewer (Richards and Barry, 1998). This enormous difference in life expectancy by education is true for every demographic group, is persistent -if not increasing -over time (Kitagawa and Hauser, 1973;Elo and Preston, 1996; Meara, Richards, and Cutler, 2008), and is present in other countries (Marmot, Shipley, and Rose, 1984 (the U.K.); Mustard, et al. 1997 (Canada); Kunst and Mackenbach, 1994 (northern European countries)). 1 A major reason for these differences in health outcomes is differences in health behaviors. 2 In the United States, smoking rates for the better educated are one-third the rate for the less educated. Obesity rates are half as high among the better educated (with a particularly pronounced gradient among women), as is heavy drinking. Mokdad et al. (2004) estimate that nearly half of all deaths in the United States are attributable to behavioral factors, most importantly smoking, excessive weight, and heavy alcohol intake. Any theory of health differences by education thus needs to explain differences in health behaviors by education. We search for explanations in this paper. 3 In standard economic models, people choose different consumption bundles because they face different constraints (for example, income or prices differ), because they have different beliefs about the impact of their actions, or because they have different tastes. We start by showing, © 2009 Elsevier B.V. All rights reserved. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 1 See Cutler and Lleras-Muney (2007) for additional references. 2 Observed health behaviors however do not explain all of the differences in health status by education or other SES measures. We do not focus on this issue in this paper. 3 Formal explanations for this phenomenon date from Grossman (1972) although there was less formal d...

There is a large and persistent association between education and health. In this paper, we review what is known about this link. We first document the facts about the relationship between education and health. The education 'gradient' is found for both health behaviors and health status, though the former does not fully explain the latter. The effect of education increases with increasing years of education, with no evidence of a sheepskin effect. Nor are there differences between blacks and whites, or men and women. Gradients in behavior are biggest at young ages, and decline after age 50 or 60. We then consider differing reasons why education might be related to health. The obvious economic explanations-education is related to income or occupational choice-explain only a part of the education effect. We suggest that increasing levels of education lead to different thinking and decision-making patterns. The monetary value of the return to education in terms of health is perhaps half of the return to education on earnings, so policies that impact educational attainment could have a large effect on population health.

Prior research has uncovered a large and positive correlation between education and health. This paper examines whether education has a causal impact on health. I follow synthetic cohorts using successive U.S. censuses to estimate the impact of educational attainment on mortality rates. I use compulsory education laws from 1915 to 1939 as instruments for education. The results suggest that education has a causal impact on mortality, and that this effect is perhaps larger than has been previously estimated in the literature.

The pleasures of life are worth nothing if one is not alive to experience them. Through the twentieth century in the United States and other high-income countries, growth in real incomes was accompanied by a historically unprecedented decline in mortality rates that caused life expectancy at birth to grow by nearly 30 years. In the years just after World War II, life expectancy gaps between countries were falling across the world. Poor countries enjoyed rapid increases in life-expectancy through the 1970s, with the gains in some cases exceeding an additional year of life expectancy per year, though the HIV/AIDS epidemic and the transition in Russia and Eastern Europe have changed that situation. We investigate the determinants of the historical decline in mortality, of differences in mortality across countries, and of differences in mortality across groups within countries. A good theory of mortality should explain all of the facts we will outline. No such theory exists at present, but at the end of the paper we will sketch a tentative synthesis.