Increased School Quality: A Possible Strategy to Promote Health

Introduction: Educational attainment is a well-established social determinant of health.  It affects health through many mechanisms such as neural development, biological aging, health literacy and health behaviors, sense of control and empowerment, and life chances. However, what is it, specifically, about education that affects health? A literature on the relationship between the educational experience and health outcomes is beginning to emerge, and suggests that school quality may be associated with a wide array of health outcomes, including self-reported health, health behaviors, obesity, and mortality.

Methods: In a sample of 400 diverse community-dwelling older adults in California who were surveyed about their childhood socioeconomic experience and current health outcomes, we used multivariable regression to elucidate the associations between several measures of the educational experience (school quality, discrimination at school, school racial/ethnic and socioeconomic characteristics, and parental support for education) and three diverse measures of health (self-rated health, hypertension, and physical functioning), adjusting for educational attainment and other covariates. 

Results: Educational attainment was strongly associated with each of the three health outcomes.  However, educational attainment was linearly associated with self-rated health and hypertension, whereas a non-linear functional form was observed for educational attainment as it related to physical functioning. A global measure of school quality was also associated with better self-rated health, having a majority white school was associated with lower odds of hypertension, and no additional measures of the educational experience were associated with physical functioning. For example, for each additional year of education, adjusting for school quality, the odds of increasing one level in self-rated health was 1.23 (95%CI: 1.14, 1.34). For each additional unit of self-rated school quality, adjusting for educational attainment, the odds of increasing one level in self-rated health was 1.39 (95%CI: 1.08, 1.77).

Conclusion: Our review of the literature and our analyses suggest that health benefits arise from high-quality education across an individual’s educational experience. Additionally, much research to date has focused on objective measures of school quality. Our analysis suggests that subjective measures of the educational experience are worth considering.  Further research is needed to further understand the nuanced relationship between the educational experience and health, since the observation that characteristics of the educational experience may be associated with health outcomes has implications for policy and practice in education, public health, and prevention.