Education as a Social Determinant of Health

A young student solves a math problem on a chalkboard.

Eating healthy, getting regular medical check-ups, exercising and sleeping sufficiently are all behaviors well-known to influence health quality. However, studies suggest one unexpected factor that can predict how long people will live: education.

Education gives people the tools they need to lead fulfilling lives, thrive personally, and contribute to their communities. In addition, education makes it more likely a person can access quality healthcare, find employment that pays a living wage, and live in a safe, non-polluted environment — all factors that affect well-being. In fact, people who live in lower socioeconomic conditions are at greater risk for a host of health issues, including higher rates of disease, mental illness, and premature death, according to Healthy People 2020.

Access to quality education early in life, high school graduation, and a college education can all provide opportunities for people to shift their socioeconomic status, reducing the likelihood of these negative health outcomes in return. Because of this, understanding how education impacts the health of communities is vital for public health professionals fighting to end health inequity.

Social Determinants of Health

Good health is central to living well. The absence of disease and injury alone does not make people healthy. Healthy people enjoy a combination of physical, mental, and social well-being, three aspects of health that all influence one another.

Physical health refers to the body’s ability to function at its best, resist disease, and recover from illness and injury, while mental health focuses on one’s ability to enjoy life, adapt and respond to setbacks, and manage depression and anxiety.

While defining physical and mental health may seem clear cut, social health can seem more nebulous. So what is social health and how does it play into a person’s overall well-being?

Social health has to do with the ability to form satisfying personal relationships and interact with others in healthy ways. Can a person make connections with family or neighbors and share thoughts and feelings about a disappointing rejection from a love interest or an exciting job prospect? Social health allows people to feel a sense of belonging. In this case, people sense they have allies in the world, people who will celebrate with them at the birth of a child and mourn with them at the loss of a loved one.

Socially healthy people can also adapt to different social situations. They can make new friends when they move into a new neighborhood, communicate with their children’s teachers during parent-teacher conferences, and relax at a weekend barbecue with friends. Not surprisingly, social health usually comes out of living in conditions where a person experiences social support either from family, friends, or counselors. Having adequate social support can reduce the negative effects of stress and disease.

All three aspects of health can impact one another. For example, poor physical health can lead to depression and affect a person’s outlook on life as well as add to feelings of loneliness and social isolation. Conversely, poor mental health often leads to physical problems such as a weakened immune system, insomnia, or high blood pressure. However, a solid social support network can improve people’s chances to get the help they need for mental and physical health issues.

Many factors, or social determinants of health, affect a person’s overall health and well-being. Where people live, work, go to school, and socialize, and the conditions of those environments, all play a significant role because they can be an indicator of economic stability, access to quality health care, social and community context, and neighborhood and built environment.

Consider the physical, mental and social health effects of living in a run-down home full of lead paint, working a full-time job that offers poverty wages and no paid leave, or attending a short-staffed school located in a crime-ridden area. Lead paint exposure can cause brain damage in children, and neglected schools can leave students feeling isolated and hopeless. A lack of paid leave can get in the way of a family’s access to consistent health care. Residents of neighborhoods with high crime rates feel less safe.

Economic Stability

Economic stability includes elements such as work environment and wages, sufficient money for food and housing, and socioeconomic status. Each of these factors can affect health in different ways. For example, someone like a police officer, who works in a high-pressure environment, may experience psychosocial stress, while a factory worker may be exposed to toxic chemicals that cause disease.

Studies cited in Healthy People 2020 show that people who can’t buy enough food are more likely to experience chronic diseases and children who face food insecurity are at increased risk for obesity, malnutrition, and developmental problems.

Additionally, when people spend 30% or more of their salaries on housing, they often have little money for other necessities like nutritious food or prescription medications. Such a housing-cost burden can also lead to frequent forced moves, which studies show increases the risk of chronic health conditions in children and limits access to consistent health care and education. When people’s financial circumstances force them to choose between paying for insulin to control their diabetes and buying a bus ticket to get to work, they are faced with a dilemma that creates stress.

Education

People who have access to quality education throughout their lives tend to stay healthier than people who don’t. Not only does education give individuals a chance at upward mobility, which places them in better financial circumstances to access quality health care, it also keeps them better informed about how to take care of their health. For example, an individual with a college degree may have better skills to evaluate conflicting or complex information they read on the internet about how to care for their prediabetes. In addition, someone with less formal education may be less prepared to decide between reliable and unreliable information.

Less education is linked to lower income, which is linked to poorer health. Numerous studies show that people in lower socioeconomic situations experience more obesity, asthma, diabetes, heart disease and other health problems than people in better financial circumstances.

Additionally, a recent study also shows higher education helps individuals secure higher paying work with fewer safety risks. Ultimately, more highly educated people have greater economic resources to afford things like better housing far away from environmental toxins and expert doctors trained in the most effective techniques.

Social and Community Context

Social and community context, another important social determinant of health, encompasses:

  • Civic activities - voting, volunteering, and participating in community groups
  • Social cohesion - solidarity between community members
  • Discrimination
  • Incarceration

These elements can affect health in various ways. For example, people who participate in civic and community activities can make social connections, become more physically fit, and better manage mental health issues like depression. Consider how joining a bi-weekly tai chi or play-reading class at a local community center could improve a senior’s sense of belonging, or how volunteering at a food bank could help a depressed teenager feel a sense of purpose. While physically distancing during COVID-19, participating in social community events virtually and connecting with others over video chat can also have a positive effect on overall health and wellbeing.

Structural discrimination, or policies in public and private institutions that disproportionately affect particular groups, can also impact health. Unequal access to housing and health care, or policies that result in disproportionate interactions with the criminal justice system increase psychosocial stress and mental health problems, according to Healthy People 2020. New York City’s stop and frisk policing is one example of a policy that involved aggressive detaining and searching of millions of New Yorkers, mostly Latinos and African Americans, and resulted in greater levels of anxiety and depression, according to a recent study.

Health and Health Care

Access to primary health care, a regular source of care that detects and treats diseases and provides preventative services, is an important part of staying well. However, when barriers, such as inadequate health insurance coverage or a shortage of care providers prevent people from getting these services, health suffers.

Fewer people die from cancer, heart disease, and stroke when they have access to primary care, according to the American Academy of Family Physicians. That’s because primary care gives individuals a chance to pay attention to their health. For instance, an Oregon study on Medicaid found that uninsured adults with diabetes who gained access to health care through Medicaid, significantly increased their use of needed diabetic medications.

What empowers people to care for their own health? Health literacy, or the ability to obtain and understand health information, is an important tool. Individuals who understand various health risks and the precautions that can reduce those risks can better safeguard themselves.

For instance, knowing the risks of sexually transmitted infections and ways to avoid them allows people to take steps to keep themselves healthy. Additionally, a recent study found an association between low health literacy and more hospitalizations, fewer mammography screenings and flu vaccines, and higher mortality rates among the elderly.

Neighborhood and Built Environment

Environmental conditions where people live, access to healthy foods and quality housing, and the absence or presence of violence and crime, all play a significant role in people’s health.

To help prevent obesity, high blood pressure, and diabetes, diets should include fresh fruits and vegetables, whole grains, protein and limited saturated fats. However, living in neighborhoods that lack grocery stores that sell fresh nutritious foods (i.e., food deserts) or lacking the money to purchase these foods puts people at a greater risk for poor health.

Environmental contaminants affect the air people breathe, the water they drink, and the chemicals they are exposed to. Communities living near landfills can breathe in methane and carbon dioxide, which cause strained breathing, nausea and fatigue, and even loss of consciousness. Further, people living in houses with mold, poor plumbing, and poor ventilation can experience increased asthma, respiratory problems, lead poisoning, and carbon monoxide poisoning.

Finally, crime and violence also factor into people’s well-being. Those who experience crime and violence not only endure physical pain and injury, but may also experience depression, suicidal thoughts and anxiety.

Additionally, violence and crime have other effects. People who live in high crime neighborhoods may avoid going outside out of fear for their safety. This lack of physical activity can lead to negative health outcomes. In fact, one study found that people who feel unsafe in their neighborhoods experience higher levels of obesity.

When so many factors contribute to a person’s well-being, few can deny education as a social determinant of health. Countless links between education and health show that individuals with higher levels of education live healthier and longer lives than those who are less educated.

Starting from early childhood, research shows links between access to education and better health. Healthy People 2020 cites studies that show how early childhood programs can foster physical and mental development. Children attending Head Start, an early learning program that prepares young children from low income households for elementary school, for example, will likely lead those children to experience health benefits both during and after their participation in the program.

On the other hand, children enrolled in schools lacking in health resources and teacher support tend to experience poorer physical and mental health. Educational opportunities earlier in life have lasting effects on health through adulthood. A study by the Carolina Abecedarian Project found that those who participated in quality early childhood education programs engaged in fewer risky behaviors like binge-drinking and cigarette smoking at age 21.

Benefits of early comprehensive education programs extend ever further. According to a recent report, adults who participated in these programs as children were at lower risk for obesity, high blood pressure, elevated blood sugar, and high cholesterol in their mid-30’s.

The inclination to eat a salad instead of French fries, or bike to work instead of drive is cultivated early in a person’s life. The evidence makes a solid case for investing in early childhood education programs.

Completion of high school can also serve as a health indicator. Healthy People 2020 cites numerous studies that found links between dropping out of high school and premature death and poor health. Additionally, the article “Dropping Out of School and Chronic Disease in the United States” found that those who do not graduate high school report having at least one chronic health condition such as hepatitis, stomach ulcers, or heart disease.

A college education is associated with even greater health benefits. Research shows that with increasing levels of college education people are less likely to die from cancer and cardiovascular disease. College graduates also report better health compared to high school graduates. One study found 13% of study participants with a high school degree or less died prematurely, while only 5% of the college graduates died prematurely.

Why the links between higher levels of education and better health? In many ways, the connection between the two is clear cut. Most people find their way to financial stability through education. Greater financial stability allows for increased access to good health insurance and safe housing in unpolluted environments. In turn, access to doctors creates more opportunities for people to gain important information about their health. In addition, education prepares people to analyze information and manage complex problems, critical skills needed to navigate today’s complicated healthcare system.

Improving Healthcare Equity Through Education

Many variables within education are linked to health: literacy, high school graduation, and enrollment in higher education each present opportunities to improve education and thereby promote health equity. By researching solutions and initiating programs that address education disparities, public health professionals can create pathways that lead people to healthier lives.

Limited health literacy and limited general literacy can prevent people from learning about health, using medication properly and taking advantage of preventative services, according to several studies cited in Healthy People 2020. For example, someone with poor health literacy about their epilepsy might take their anti-seizure medications irregularly and actually provoke seizures as a result. Further, someone with poor literacy in general may have difficulty evaluating and applying explanations from their doctor about how to manage their condition.

Limited English proficiency creates similar barriers. Health care providers and organizations need to develop and use methods that will help diverse populations understand and make good decisions about their health.

Well-designed plans can address barriers to good health. The CDC developed the “Health Action Literacy Plan,” which makes health information more accessible and offers a framework that other health care organizations can use to address literacy issues.

The plan’s goals include incorporating health and science curricula into education from early childhood education through college. Some health literacy toolkits recommend healthcare providers and organizations develop ways to simplify health communication and integrate comprehension checks into interactions between patients and their providers.

Ensuring high school graduation is another important step in promoting health equity. Programs centered on increasing high school graduation rates need to address risk factors such as safety issues and violence in schools, pregnancy, and below-grade reading levels that often lead students to dropping out, according to Healthy People 2020.

Another study found that high school programs with the following elements also increase graduation:

  • Vocational training
  • Alternative schooling (small class sizes with focused remediation on the issues problematic for the student)
  • Social-emotional skills training

Just as targeted programs can help students graduate high school, they can also encourage students to attend college. Initiatives that guide high school students through the college admission and financial aid application processes can help students overcome barriers to going to college. Furthermore, programs that help students advance their math and reading skills can improve college enrollment rates as well.

In addition, a recent study argues for expanded remedial education, financial aid, and student support services. The study recommends these efforts to ensure all students have a chance to attend and succeed in college.

While such programs are critical, efforts to get students into college must start much earlier. Strengthening primary and secondary curricula must be a priority.

Careers in Public Health Education

Do you want to find solutions that address the social determinants of health? By joining the comprehensive efforts of private and public organizations, public health experts help develop, implement, and analyze initiatives that promote health and address health inequities. Public health professionals play a key role in program coordination, health advocacy and education, management, and community health services.

Careers in public health education fall under several umbrellas, including community health education, school health education, business and nonprofit health education, academia, government and health departments, and health care. Within these categories public health professionals can find work opportunities that suit a range of expertise and interests.

Health Programs Management Directors work in an academic capacity as public health advocates who develop and implement programs that promote health and wellness. They usually work in either clinical or office environments.

Education Program Managers tackle many vital roles, including the coordination and planning of health educational programs. These programs focus on topics such as reproductive health, nutrition, and teen pregnancy prevention, among others. Education Program Managers often conduct community outreach and develop curricula that educates on specific health topics.

Directors of Outreach and Partnerships manage strategic coalitions, create partnerships with other organizations and oversee public education programs. They may oversee the development of outreach and health educational materials, as well as deliver educational presentations and webinars.

Finding Solutions That Promote Health Equity

Public health professionals play a critical role in protecting people’s health and preventing health issues before they start. Their work may involve assessing and addressing the health risks of a community exposed to lead in their water or developing a pediatric dental hygiene education program for children with frequent cavities. By educating communities about healthy lifestyle choices, creating programs that make health care and social support more accessible, and advocating for policies that ensure everyone has safe food and water, public health professionals help address social determinants of health to promote health equity.

Public health professionals collaborate with doctors, nurses, and other healthcare professionals but their reach extends beyond the medical world. They achieve their goals to improve health by partnering with educators, city planners, first responders, and child welfare workers. They coordinate across organizations, offering epidemiological information to emergency responders, and they empower communities to take charge of their own well-being.

Inspired by the opportunity to innovate solutions that address health inequities? Learn more about Tulane University’s Online Master of Public Health to find out how public health professionals help build a more equitable and just world.

Agency for Healthcare Research and Quality, “AHRQ Health Literacy Universal Precautions Toolkit”

American Academy of Family Physicians, “Why Primary Care Matters”

American Journal of Preventative Medicine, “Programs to Increase High School Completion

A Community Guide Systematic Health Equity Review”

Annual Review of Public Health, “The Relationship between Education and Health: Reducing Disparities through a Contextual Approach”

Center for Disease Control and Prevention, “CDC’s Health Literacy Action Plan”

Encyclopedia.com, Social Health

Epilepsy Foundation, “Importance of Taking Medication on Schedule”

Future Child, “Young Adults and Higher Education: Barriers and Breakthroughs to Success”

Health Affairs, “Paid Family Leave Policies And Population Health”

Health Affairs, “The Public Health Workforce”

Healthy People 2020, “Social Determinants of Health”

International Journal of Environmental Research and Public Health, “Education as a Social Determinant of Health: Issues Facing Indigenous and Visible Minority Students in Postsecondary Education in Western Canada”

International Journal of Health Services, “Education Improves Public Health and Promotes Health Equity”

Inverse, “Mortality Rate by Education Level: Chart Shows Where People End Up”

Medical News Today, “What Is Good Health?”

National Commission for Health Education Credentialing, Guide to Health Education Careers

New York State Department of Health, “Important Things to Know About Landfill Gas”

Office of Head Start, Head Start Programs

Plan4Health, “Education Is a Social Determinant of Health”

The Journal of Nutrition, “Food Insecurity Is Associated with Chronic Disease among Low-Income NHANES Participants”

The Nation’s Health, “Education Makes Healthy Choices Easier, Beginning Early in Life”

The New York Times, “Does Your Education Level Affect Your Health?”

The New York Times, “The Lasting Effects of Stop-and-Frisk in Bloomberg’s New York”