Both education and income can determine whether a person will remain healthy, but those who stay in school longer have the best odds, largely because education so strongly influences income, say the authors of a new study.

“Those with less education are more likely to develop health problems and those with low incomes who already have health problems are more likely to see their health worsen,” said lead author Pamela Herd, a University of Wisconsin-Madison sociologist.

The study appears in the September issue of the Journal of Health and Social Behavior and examines how health differences in the United States often relate to people’s socioeconomic status. Herd and colleagues say education influences occupation, income and wealth — and with higher education comes healthier behaviors, such as good diet, increased physical activity, reduced stress, and better use of preventive and therapeutic healthcare.

The authors used data collected from 1986 to mid-2002 in the “Americans’ Changing Lives Study,” which conducted four waves of interviews of adults who were 25 years old and older. Herd and colleagues analyzed data for 8,287 participants.
They looked at two groups of health problems: chronic conditions and functional limitations or disabilities.

Compared with those with a college degree, the odds of having health problems were 81 percent higher for those without a high school diploma and 56 percent greater for those with a high school diploma.

When comparing income, the researchers found that those with incomes of less than $10,000 had a 35-percent greater chance of developing health problems than those who made more than $30,000. In addition, those with incomes less than $10,000 had a 195-percent greater chance that their health problems would get worse.

Herd said the results show this country’s education policy must improve to reverse these types of disparities.

“Policy makers tend to focus on individual behaviors, such as smoking and obesity, to address health disparities in the population,” she said. “While it is clear that smoking and being obese are bad for one’s health, a far more effective strategy is to go the actual source of the problem. Improving access to education can address numerous intermediary causes of poor health.”

Nancy Adler, a professor of medical psychology at the University of California, San Francisco, agreed that disparities are a problem, but said the necessary fix to the health care system lies in promoting health prevention.

“Health care plays some role in disparities, but less than most people expect,” she said. “Analyses from Center for Disease Congrol and Prevention data estimate that only about l0 percent of premature mortality is due to deficiencies in health care, either because of lack of access or poor quality. More ‘action’ is in who gets sick in the first place and right now the health system does relatively little in prevention.”

The Journal of Health and Social Behavior is the quarterly journal of the American Sociological Association

Interviews: Contact Pamela Herd at pherd@lafolette.wisc.edu