Handbook of Medical Sociology, Sixth Edition

3. Why Education Is the Key to Socioeconomic Differentials in Health

33 theories focus on household income and access to medical care and health insurance as primary mediators. The debate about mediators contrasts learned effectiveness theories, which focus on human capital, with commodity theories, which focus on income and the things it can buy (Lynch 2006; Pampel and Rogers 2004; Reynolds and Ross 1998; Schnittker 2004). Pathways Linking Education to Health 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, that is, education develops habits, skills, resources, and abilities that enable people to achieve a better life (Mirowsky and Ross 1998, 2003; Sen 1997, 1999). 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 prosperity that is contingent on education. Human capital theory posits an effect of education on health over and above the good jobs that pay well and provide health insurance and the other economic benefits that stem from education. It describes a causal model which posits that education enables people to coalesce health-producing People with higher socioeconomic status have better health than lower-status individuals, and inequalities in health grow with age. Education creates most of the association between higher socioeconomic status and better health because education is a root cause of good health. 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 the age-specific rates of morbidity, disability, and mortality.1 The question is, Why? The mediators include: (1) work and economic conditions, such as employment status, creative and autonomous work, and income and economic hardship; (2) social psychological resources , including the sense of personal control and social support; and (3) health lifestyle, including patterns of smoking, exercising, walking, drinking, weight, and use of medical services. We contrast two theories that attempt to explain why education improves health: education as human capital and learned effectiveness, and education as a commodity. These theories are not mutually exclusive but emphasize different primary links between education and health. Theories of learned effectiveness posit that education improves health apart from the economic resources it brings; they focus on creative work, sense of personal control, and health lifestyle as mediators. Commodity 3 Why Education Is the Key to Socioeconomic Differentials in Health Catherine E. Ross, University of Texas John Mirowsky, University of Texas 34 Handbook of Medical Sociology 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 in part because education boosts the sense of personal control directly and in part indirectly by providing access to creative and autonomous work. Commodity theories focus on material assets. Education is a credential that employers use in allocating good jobs (Ross and Mirowsky 1999). Degrees, especially college degrees, are markers that employers use to hire. Without a college degree, it is difficult to get a job that pays well. Commodity theories focus on earnings, income, wealth, and health insurance. Education helps a person buy the things that maintain health. Commodity theories and human capital theories are not mutually exclusive, but their primary pathways between education and health differ. Like the human capital theory, the commodity theory of education and health is causal—in contrast to selection or spurious models of education and health, which posit that education does not have a causal effect on health but is simply a marker for socioeconomically advantaged family background. Most research suggests that the positive association between educational attainment and health is largely due to the effects of education on health, not vice versa (Doornbos and Kromhout 1990; Wilkinson 1986), despite the suggestion of some economists that the association is spurious. Although genetic traits like IQ lead to higher levels of education and to better health, stringent tests of unmeasured spuriousness still find effects of education on health and mortality (LlerasMuney 2005). More realistic life-course analyses posit paths in both directions: early childhood conditions, social and genetic, predispose people to better health and higher levels of education, and better childhood health leads to more education (Haas and Fosse 2008). In turn, higher levels of education improve adult health, independent of childhood traits, and also link some of the effect of childhood conditions to adult health (Best, Hayward , and...