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Education and Health: An Independent Predictor of Health or a Marker of Social Class?

Education has a direct relationship with health– the more educated an individual, the more he/she can bring these resources and faculties to bear in making decisions about healthy lifestyle habits and navigating the complex health care system and its various treatment alternatives. Greater education of individuals about specific health threats, coupled with some elementary health psychology to motivate individuals to make use of this information, has been a staple of public health practice in the U.S.

However, at the same time, education is also a marker of social class, which has been shown to have an independent, though less well understood effect on health. Education and income often vary together and when combined are used as markers of social class. But what exactly is it about social class that predicts health? Researchers have proposed various explanations including social stress theory and neo-material theories about the relationship between social class and well-being.

Neomaterial theories argue that differential access to knowledge, prestige and power among individuals lower in the socio-economic spectrum leads to behaviors that increase risk for certain illnesses. Social stress theory argues that in addition to differences in health behaviors, psychosocial stress among individuals lower in the social hierarchy contributes to worse health outcomes including higher rates of chronic illnesses such as cancer and heart disease through biological processes.

Either way, lower education is correlated with worse health outcomes. The difference in interpretation of these causal factors has policy significance, however.

Researchers who emphasize a direct link between education and health argue that all that is needed to reduce health disparities is to educate people more about specific health threats.  If people just had more knowledge, according to this logic– health outcomes would be improved.

Explanations for health disparities that emphasize a role for social class, on the other hand, recognize that the reality is more complex than simply educating people more about specific health threats. Social class theories recognize that people have differential access to the means to be healthy and that systematic barriers exist that prevent individuals from making use of available information.

The latter theories would dictate policy solutions that rely on a transformation of the class structure, including greater redistribution of resources towards those lower in the spectrum. Because this latter explanation calls for policy solutions that are politically unpopular and more difficult to achieve, they gain less traction than research that emphasizes the direct linkages between health and education.

These findings about the relationship between health and social class make a powerful case relevant to current struggles in the face of the Great Recession.  If the latter theory is correct, the radically increasing inequality in the U.S. may have dramatic health consequence in the years to come.

With the debt crisis and recession being used as  a pretense to cut back on the few social programs that have dramatically reduced inequality over the past several decades, we can expect disparities in health outcomes to increase as well as the overall burden of disease. Inequality kills, and the debt crisis is not just a debate over ideology but a debate over life and death itself.

About Ashley Fox

Ashley Fox, Ph.D., is an Assistant Professor at the Mount Sinai School of Medicine, Department of Health Evidence and Policy. Learn more about Ashley here.

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