Why Education Matters to Your Health

Across America, people are falling ill and dying young.

These men and women have something in common. In fact, they stand out because of something they don’t have: a college degree.

A recent report, by the Princeton University economists Anne Case and Angus Deaton, made the stakes clear: Men and women who haven’t been to college live shorter, less healthy lives, and are losing ground compared with college graduates.

Read the full story: Across America, there’s a new public-health crisis — the lack of a college degree.

This is about more than money — the findings suggest that pain, stress, and social dysfunction may all play a role. Here’s what you need to know about the research.

Ms. Case and Mr. Deaton found that less-educated Americans were dying younger. Is that really so striking?

In a word, yes. For decades, life expectancy for Americans has been improving, thanks to advancements in technology and medical care. Before 1999, middle-age mortality rates were declining by about 2 percent a year. But suddenly, starting in the late 1990s, rates of morbidity and mortality — in other words, of sickness and death — began to increase for white men and women between the ages of 45 and 54 who did not have a college degree.

Since then those rates have been climbing by about half a percentage point a year among the white working class. “In this historical context of almost continuous improvement,” write Ms. Case and Mr. Deaton, “the rise in mortality in midlife is an extraordinary and unanticipated event.”

The researchers originally noticed rising death rates among the middle-aged and now see a similar deterioration for less-educated adults of all ages. The one exception is the elderly.

At the same time, however, longevity has continued to improve for people who hold college degrees. The resulting disparity is striking: The mortality rate for 50- to 54-year-old men without a bachelor’s degree is 867 per 100,000; for their more-educated peers, it’s just 243. While there’s long been a gap in health outcomes based on education, it looks now more like a yawning gulf.

Is this just another way of saying that poor people are sicker?

Yes, but that’s not all that’s going on. People with steady, well-paying jobs tend to be in better health, and that’s especially true in the United States, where we have a system of employment-based health insurance. But the relationship between education and health is significant and independent of socioeconomic status.

So, what’s going on? Why does education matter?

That’s not an easy question to answer. Experts say there are all sorts of links between education and health, and whether there’s a direct relationship between the two isn’t entirely clear. People with degrees have more and better access to health care. They report greater job satisfaction and lower levels of stress. They read up on scientific breakthroughs and heed their doctor’s advice when it comes to behaviors like eating healthfully, exercising, and quitting smoking. They are less likely to live near factories or freeways that belch pollutants into the air and are more apt to be surrounded by people like them, who reinforce healthful living. As one public-health researcher put it, the well-educated have a deeper bucket of resources to draw on.

Ms. Case and Mr. Deaton, the Princeton economists, have their own idea, linking the increasing mortality rate to an uptick in deaths from drug and alcohol abuse and from suicide — what they call “deaths of despair.” Their theory goes like this: Over the past several decades, the economy has shifted, eliminating many of the jobs that once went to people without college degrees. The share of men in their prime working years, ages 25 to 54, who are not in the work force has more than tripled since the late 1960s. Those who do have jobs are unlikely to be pulling in the same sorts of wages as generations before them.

Unable to provide a middle-class life, they may put off marriage; their social ties are often weaker. People without college degrees report being less happy than those with more years of schooling. As a result, they may turn to alcohol or drugs to cope. Deaths from opioids, in particular, have been soaring, and most of those who overdose are white.

In short, the tough labor market may be at the root of the worsening mortality rates for those without higher education, but that’s not the only thing to blame. Instability, dysfunction, stress: these cumulative disadvantages add up, exacting a deadly toll.

You’ve mentioned several times that death rates have climbed specifically for white Americans. Why focus on white people? Wouldn’t members of minority groups be similarly affected by changes in the economy?

Fair point — if anything, black and Hispanic Americans suffer from greater educational and economic inequities than their white counterparts do. Yet they have continued to show improvements in health and longevity. Partly it’s that they’ve long suffered from ill health and earlier deaths. Even with progress, there’s still a long way to go.

In fact, a new study from the University of North Carolina at Chapel Hill suggests that black and Hispanic young adults from poor backgrounds actually are in worse physical health if they complete college.

Experts like Andrew J. Cherlin, a sociologist at the Johns Hopkins University, speculate that racial differences also might be a matter of expectations. It wasn’t long ago that white working-class Americans could count on leading a comfortable life with just a high-school degree. Middle-aged men and women, the very group falling ill and dying, are the first generation without that guarantee. They compare themselves with their parents and find their lives falling short. For black and Hispanic Americans, if you haven’t got as much to hope for, you might just have less to lose.

Come to think of it, you keep talking about Americans. What about people in other countries who don’t have college degrees? Are they, too, getting sicker?

They’re not. Even right next door in Canada, longevity continues to improve. One reason might be that workers in other industrialized countries haven’t experienced the same wage stagnation as have those here. But it’s also the case that in Canada and throughout Europe, the social safety net is more pronounced.

If where you live in the world makes a difference, are there healthier places within the United States?

Ms. Case and Mr. Deaton play down geography in their work, saying that they spot the trend of increasing mortality across all regions of the country and in both rural and urban areas. But other researchers argue that location does matter. Rural America has been hit hard by the changing economy, and the people there tend to be older, white, and less-educated than those in the cities and suburbs.

What’s more, a lot of public policy that affects the poor and less educated is set at the state and local levels, points out Jennifer Karas Montez, an assistant professor of sociology at Syracuse University. That means there are places where it’s tougher to be poor and without a degree.

What’s the solution: Just send more people to college?

Few experts think that the answer is college for all. Instead they call for policy fixes that could help ease the disadvantage that comes from not having a degree. As a country, they argue, we should find more ways into the middle class that don’t require a four-year degree, such as more-robust apprenticeship or training programs.

They also call for strengthening the social safety net. States, for instance, could expand health coverage under the Affordable Care Act to help the working poor. They could raise cigarette taxes to make smoking cost-prohibitive for low-income residents. Education will still matter, but policy choices could mitigate its effect on health.

It’s true that more people today are earning college degrees, but perhaps that precisely why we ought to be worried about those who don’t. While this group may be smaller, the disadvantages they face are compounding, and they are falling further behind. The divide between the haves and have-nots is widening.

Karin Fischer is on Twitter @karinfischer, and her email address is karin.fischer@chronicle.com.