Education, Social Status, and Health

John Mirowsky

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9780202307060
• eBook ISBN: 9781351328067
• Topic: Social Sciences
• Subtopic: Social Classes & Economic Disparity
• Index: Social Sciences

Education forms a unique dimension of social status, with qualities that make it especially important to health. It influences health in ways that are varied, present at all stages of adult life, cumulative, self-amplifying, and uniformly positive. Educational attainment marks social status at the beginning of adulthood, functioning as the main bridge between the status of one generation and the next, and also as the main avenue of upward mobility. It precedes the other acquired social statuses and substantially influences them, including occupational status, earnings, and personal and household income and wealth. Education creates desirable outcomes because it trains individuals to acquire, evaluate, and use information. It teaches individuals to tap the power of knowledge. Education develops the learned effectiveness that enables self-direction toward any and all values sought, including health.

For decades American health sciences has acted as if social status had little bearing on health. The ascendance of clinical medicine within a culture of individualism probably accounts for that omission. But research on chronic diseases over the last half of the twentieth century forced science to think differently about the causes of disease. Despite the institutional and cultural forces focusing medical research on distinctive proximate causes of specific diseases, researchers were forced to look over their shoulders, back toward more distant causes of many diseases. Some fully turned their orientation toward the social status of health, looking for the origins of that cascade of disease and disability flowing daily through clinics.

Why is it that people with higher socioeconomic status have better health than lower status individuals? The authors, who are well recognized for their strength in survey research on a broad national scale, draw on findings and ideas from many sciences, including demography, economics, social psychology, and the health sciences. People who are well educated feel in control of their lives, which encourages and enables a healthy lifestyle. In addition, learned effectiveness, a practical end of that education, enables them to find work that is autonomous and creative, thereby promoting good health.

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Education As Learned Effectiveness

A great deal of evidence suggests that educational attainment leads to better health. Education increases physical functioning and subjective health among adults of all ages, and decreases morbidity, impairment, and mortality. Few social scientists studying health would find reason to doubt that educational attainment improves health. The question is how.

How does education foster health? The concept of human capital implies that education improves health because it increases effective agency on the part of individuals. According to the theory we develop in this book, education develops habits, skills, resources, and abilities that enable people to achieve a better life. To the extent that people want health, education develops the means toward creating that end through a lifestyle that promotes health. Thus health is not just a lucky but unintended consequence of the economic prosperity that is contingent on education. In this book we extend human capital theory beyond the economic concerns of productivity and wages to individual health. We develop and test our theory of “education as learned effectiveness.” We propose that education enables people to coalesce health-producing behaviors into a coherent lifestyle, and that a sense of control over outcomes in one’s own life encourages a healthy lifestyle and conveys much of education’s effect.

Some research on socioeconomic status and health uses education and income as interchangeable indicators of socioeconomic status. In contrast, we argue that education and income indicate different underlying concepts. Schooling means something apart from socioeconomic status. According to a human-capital perspective of learned effectiveness, education indicates the accumulated knowledge, skills, and resources acquired in school. Income indicates economic resources available to people. Both likely affect health, but for different reasons. Further, education and income are not on the same causal level, so combining them obscures processes. Education is the key to people’s position in the stratification system; it decreases the likelihood of being unemployed and gives people access to good jobs with high incomes. Part of education’s effect on health may be mediated by economic resources, but most is not. Some researchers think that education as important to health mostly because it provides high incomes. We present a different view.

Education, Learned Effectiveness, and Health

Education is a root cause of good health. Education gives people the resources to control and shape their own lives in a way that protects and fosters health. The more years of schooling people have, the greater their stock of human capital—the productive capacity developed, embodied, and stocked in human beings themselves. Schooling builds skills and abilities that people can use to achieve a better life. To the extent that people want good health, education develops the means toward creating that end through a lifestyle that promotes health. A large part of the reason the well-educated experience good health is that they engage in a lifestyle that includes walking, exercising, drinking moderately, and avoiding overweight and smoking. High levels of personal control among the well-educated account for much of the reason they engage in a healthy lifestyle.

The skills learned in school increase effective agency. In this book we will develop our ideas about “education as learned effectiveness.” Learned effectiveness is the opposite of learned helplessness. People who feel helpless see little connection between their actions and important outcomes in their lives, they think there is not much they can do to improve their situation, so they lack motivation and persistence and are likely to give up. Education helps people avoid feelings of helplessness by providing resources that reduce actual helplessness and increase effectiveness. These resources are not mostly external to people, like money; instead they are resources that inhere in the people themselves. Education gives people a sense of control over their lives that increases the motivation to attempt to solve problems and increases their success in doing so. Good health is important to most people. Education helps people achieve the goal of good health. Education is associated with physical well-being—with feeling healthy, energetic, and fit, avoiding physical impairment and chronic diseases, and escaping frequent backaches, headaches, being in pain, or feeling run-down and tired.

According to our view of “education as learned effectiveness,” schooling builds real skills, abilities, and resources that ultimately shape health and well-being. Education develops general cognitive skills. On the most general level, education teaches people to learn. Education develops the habits and skills of communication: reading, writing, inquiring, discussing, looking things up, and figuring things out. It develops analytic skills of broad use such as mathematics, logic, and, on a more basic level, observing, experimenting, summarizing, synthesizing, interpreting, classifying, and so on. Because education develops the ability to gather and interpret information and to solve problems on many levels, it increases control over events and outcomes in life. Moreover, in education, one encounters and solves problems that are progressively more difficult, complex, and subtle. The process of learning builds problem-solving skills and confidence in the ability to solve problems. Education instills the habit of meeting problems with attention, thought, action, and persistence. In school people learn to work hard, to plan, to be self-motivated, responsible, and not to give up. Even if the knowledge learned in school had no practical value, the process of learning builds the confidence, motivation, and self-assurance needed to attempt to solve problems. Thus, education increases effort and ability, the fundamental components of problem-solving effectiveness. The process of learning builds the confidence and self-assurance needed to attempt to solve problems, and it builds general cognitive skills such as thinking, analyzing, and communicating needed to successfully solve problems. These skills increase effectiveness in all aspects of life. In higher education, people also learn specific skills like chemistry, foreign languages, engineering, social work, geology, psychology, business, and nursing. This is where the general means of solving problems are tailored to a specific set of problems. Education develops the ability to solve problems on all these levels. The ability to solve problems increases one’s control over life.

Education is a resource that inheres in the person. The ability to learn, to be persistent, to communicate successfully, to search out and use information, or to figure out the cause of a problem and solve it are things that nobody can take away. No one can take away your ability to make a better life for yourself. Education puts control in the hands of people themselves. Control does not rest in the hands of others. A paycheck, a welfare check, or a social security check is not a resource that is part of you. Somebody gives it to you, and someone can take it away. As the developmental psychologist Alan Ross wrote about the time he and his family were fleeing Nazi Germany with no material possessions, “All we had with us were the things we had learned, and our ability to learn more” (Ross 1991:191).

Because education is a resource that inheres in the person, it can substitute when other resources are absent. For instance, individuals who are well-educated need less money to fend off economic hardship than those with less education. The principle of resource substitution implies that education will be most valuable to those with few other resources. Of course, the well-educated are more likely to have those other types of resources, like jobs and money, thereby amplifying the health advantages of the well-educated and disadvantages of the poorly educated.

Individual responsibility and structured disadvantage often get contrasted as rival explanations of differences in health. Contemporary health science and popular culture alike put heavy emphasis on behaviors and lifestyles. Researchers who see health as a function of a social structure that allocates resources unequally (Crawford 1986) sometimes criticize the view that health is determined by lifestyle characteristics such as exercise and smoking (Knowles 1977). Such critics rightly argue that emphasizing insight and choice while ignoring means and circumstance blames individuals for their own health problems while ignoring the systematic limitations and disadvantages that endlessly generate suffering. In our view neither individual choice nor structured limitation can be ignored. An effective theory of health must recognize that many essential elements of health require the personal knowledge, insight, and will of the individual. No one can decide for another whether or not to smoke cigarettes, exercise, or eat a proper diet. Many health scientists view free will as a quaint but misleading concept. None of them has yet invented the drug or written the law that will make individuals do what those individuals must choose to do themselves. In our theory of education as learned effectiveness we argue that a low sense of personal control, smoking, overweight, and a sedentary lifestyle are the means by which the disadvantages faced by persons with little schooling create poor health. Personal control and healthy lifestyle connect educational attainment to health.

Education and Socioeconomic Status

Socioeconomic status has four main components that can affect health: education, employment, work, and economic status. The first component, education, includes years of schooling and degrees. It indicates the knowledge, skills, values, and behaviors learned at school, as well as the credentials that structure job opportunities. The second, employment status, differentiates categories of labor, distinguishing among being employed full-time, employed part-time, laid off or unemployed, in school full-time, retired, or keeping house. The third, work characteristics or status, corresponds to various aspects of productive activity. It includes occupational prestige, rank and social class for employed persons, and the conditions and qualities of activity for employed persons and for others. The fourth component, economic status, includes aspects of economic well-being such as personal earnings, household income, and material or economic hardship.

Each element of socioeconomic status should be viewed as distinct, rather than as interchangeable with the others. Socioeconomic status represents general social standing in the relative distribution of opportunities and quality of life. Sometimes researchers measure general social standing by averaging together rank on a number of dimensions such as education, occupational prestige, and household income. That practice obscures two things needed for understanding the relationship of social status to health.

First, the practice of averaging different elements together obscures the differences among aspects of status in their effects on health. More is gained by understanding which aspect of status produces an effect on health. For example some research on socieoconomic status and health uses education and income as interchangeable indicators of socioeconomic status (Williams and Collins 1995). In contrast, we argue that education and income indicate different underlying concepts. Schooling means something apart from socioeconomic status. According to a human-capital perspective of learned effectiveness, education indicates the accumulated knowledge, skills, and resources acquired in school. Education also structures job opportunities (probably because employers prefer workers who can write, analyze, synthesize, plan, communicate, and so on, although some think employers just use college degrees as a social class marker). Income is money. Lack of money could affect health because of the worry or stress associated with not having enough money to pay the bills or buy food, clothes, and other necessities, or it could indicate an inability to get medical services and treatments. If education and income both affect health, it is probably for very different reasons.

Second, the practice of combining indicators obscures the causal relationships among the different aspects of social status. Education, employment, work status, and economic resources occupy ordered positions in a causal chain. To best understand how social differences in health evolve, research should represent the connections among aspects of status, not hide them. Part of education’s effect may be mediated by employment and economic status. Higher education gives people access to good jobs with high pay. According to our theory of learned effectiveness, however, education’s value to health goes beyond good jobs and economic resources. To understand the processes by which socioeconomic status affects health, education, work, and income must be distinguished and ordered sequentially: education affects the likelihood of being employed and the kind of job a person can get, and employment status and jobs in turn influence income.

Education, employment status, and income are applicable to everybody, but occupational prestige, rank, or status is not. Research that measures socioeconomic status as occupational prestige, status, or rank typically excludes people who are not employed. British researchers first recognized the consequences of social class for health, yet they almost always measured social class with reference to one’s occupation. Research that measures socioeconomic status as occupation studies people with paid jobs. Studying people with paid jobs eliminates the most disadvantaged members of society. The exclusion of people not employed for pay severely truncates variation in socioeconomic status and attenuates the effects of educational and economic inequality on health. It can obscure the extent of social differences in health. People who have been fired or laid off, the chronically unemployed, homemakers engaged in unpaid domestic labor, the nonemployed elderly, and so on, are likely the most disadvantaged in valued resources such as health. Furthermore, many of these people are women: almost all homemakers are women, and because women live longer than men, the majority of nonemployed elderly are women. By one estimate 42 percent of British women aged sixteen to sixty-four were excluded from British studies of health and social class (operationalized as occupational rank) because they had no occupation (Carstairs and Morris 1989). Finally, when all three indicators of socioeconomic status are included in predictions of health and mortality, education has the largest effect, followed by income; occupational status is typically insignificant (Kitagawa and Hauser 1973; Williams 1990; Winkleby et al. 1992).

Research on socioeconomic status and health must consider persons outside the paid labor force, as well as paid workers. Almost everyone is doing some kind of work, even if it is not paid: work like cleaning the house, cooking, shopping, doing the dishes, taking care of children or elderly family members, budgeting, making appointments, gardening, or doing volunteer work. We assess the qualities of people’s primary daily “work” or activity, paid or not: the amount of autonomy, freedom, fulfillment, enjoyment, opportunity to learn, positive social interaction, routinization, creativity, and so on.

Education is the key to one’s place in the stratification system. It shapes employment opportunities and income. Some of the reason the well-educated experience better health than the poorly educated is that they are more likely to be employed full-time rather than part-time or not at all, they have jobs that provide autonomy and the chance to do fulfilling, creative, nonroutine work, and their incomes are higher. Their higher incomes mean that they face less economic hardship in the household, that is, less difficulty paying the bills and paying for food, clothes, and other necessities for their families. Because full-time employment, fulfilling, autonomous, nonroutine work, and the absence of economic hardship are associated with good health, these paths form part of the link between education and health. Part of the reason education is associated with good health is higher socioeconomic status, but most is not.

Education as a Root Cause of Good Health

Educational attainment is a root cause of good health. Education gives people the resources to control and shape their own lives in a way that protects and fosters health. Education boosts people’s sense of personal control over their lives, which improves health in large part because it encourages a healthy lifestyle consisting of exercising, walking, drinking moderately, and avoiding smoking and overweight. We propose that a sense of personal control and a healthy lifestyle are the primary links between education and health, but they are not the only links. Education also gives people access to full-time, fulfilling work and high incomes, which help stave off economic hardship. Education further helps people build and maintain supportive relationships and avoid divorce. Socioeconomic advantages and supportive relationships also link education to good health. Thus, all pathways between education and health are positive. If there are consequences of having a college education that negatively impact health we have yet to find them. Because all the pathways between education and health are positive, we could eliminate any one mediator of the relationship between education and health, and the association would still be a positive one.

Yet, health policymakers typically do not view improved access to education as a way to improve the health of the American population. Instead they usually view improved access to medical care as the way to decrease inequality in health (Davis and Rowland 1983), despite the fact that countries with universal access to medical care have large social inequalities in health (Hollingsworth 1981; Marmot, Kogevinas, and Elston 1987). We suggest that policymakers should invest in educators and schools, not just doctors and hospitals, for better health. Unfortunately, money for health (which goes to hospitals, physicians, pharmaceutical companies, and so on) often competes directly with money for schools, especially at the state level. In addition to the obvious benefits of education to knowledge, skills, jobs, wages, economic well-being, and living conditions, broadening educational opportunities for all Americans could also improve health.

To improve the health of the American population by way of education, policymakers must take a long view. Education is a long-term strategy for improving health. If we give young people today opportunities for more and better education, the effect on their health may not be evident until they are in their fifties, sixties, and seventies, when people start to experience serious health problems. The health benefits will likely be great in the long term.

Good health and a long life are unintended consequences of schooling. Universal schooling was implemented in democracies like the United States based on the principle that the public must be informed in order to vote. Literacy is the foundation of democracy. In the United States much of the function of higher education is the development and training of employees with knowledge and skills needed by employers in industrial and postindustrial societies. Proponents of education likely understood the benefits to democracy and the political order; and to employment levels, wages, productivity, and the economic order. It is unlikely that even the proponents of education understood the tremendous health benefits of education.

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The Association between Education and Health

Health, by any definition and by any measure, increases with the level of education. The better-educated generally feel more hale, well, sound, robust, and able. They ail and suffer less often and less severely. Their medical histories show fewer and lesser signs of dysfunction in critical organ systems, and they live longer. In this chapter we define the words “health” and “healthy” as used in common English and in health surveys. We describe the measures of health we use in our surveys, and show how each correlates with level of education. In later chapters we examine a variety of possible reasons for the correlation.

Defining Health

The words “health” and “healthy” appear in writings that are amo...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Acknowledgments
• Introduction: A Rediscovery
• 1 Education as Learned Effectiveness
• 2 The Association between Education and Health
• 3 Education, Personal Control, Lifestyle, and Health
• 4 Education, Socioeconomic Status, and Health
• 5 Education, Interpersonal Relationships, and Health
• 6 Age and Cumulative Advantage
• 7 Specious Views of Education
• 8 Conclusion: Self-Direction Toward Health
• 9 Data and Measures
• References
• Index