The Relationship Between Education and Health: Reducing Disparities Through a Contextual Approach

Abstract

Adults with higher educational attainment live healthier and longer lives compared with their less educated peers. The disparities are large and widening. We posit that understanding the educational and macrolevel contexts in which this association occurs is key to reducing health disparities and improving population health. In this article, we briefly review and critically assess the current state of research on the relationship between education and health in the United States. We then outline three directions for further research: We extend the conceptualization of education beyond attainment and demonstrate the centrality of the schooling process to health; we highlight the dual role of education as a driver of opportunity but also as a reproducer of inequality; and we explain the central role of specific historical sociopolitical contexts in which the education-health association is embedded. Findings from this research agenda can inform policies and effective interventions to reduce health disparities and improve health for all Americans. URGENT NEED FOR NEW DIRECTIONS IN EDUCATION-HEALTH RESEARCHAmericans have worse health than people in other high-income countries and have been falling further behind in recent decades (137). This pattern is partially due to the large health inequalities and poor health of adults with low education (84). Understanding the health benefits of education is thus integral to reducing health disparities and improving the well-being of twenty-first-century populations. Despite extensive prior research, critical questions about the education-health relationship remain unanswered, in part because education and health are intertwined over the life spans within and across generations and are inextricably embedded in the broader social context. We posit that to inform future educational and heath policy effectively, we need to capture education in action as it generates and constrains opportunity during the early life spans of today's cohorts. First, we need to expand our operationalization of education beyond attainment to consider the long-term educational process that precedes the attainment and its effect on health. Second, we need to reconceptualize education not only as a vehicle for social success, valuable resources, and good health, but also as an institution that reproduces inequality across generations. And third, we argue that investigators need to bring historical, social, and policy contexts into the heart of analyses: How does the education-health association vary across place and time, and how do political forces influence that variation?During the past several generations, education has become the principal pathway to financial security, stable employment, and social success (8). At the same time, American youth have experienced increasingly unequal educational opportunities that depend on the schools they attend, the neighborhoods in which they live, the color of their skin, and families' financial resources. The decline in manufacturing and rise of globali...

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