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Understanding differences in health behaviors by education
Open accessAbstract
Using a variety of data sets from two countries, we examine possible explanations for the relationship between education and health behaviors, known as the education gradient. We show that income, health insurance, and family background can account for about 30 percent of the gradient. Knowledge and measures of cognitive ability explain an additional 30 percent. Social networks account for another 10 percent. Our proxies for discounting, risk aversion, or the value of future do not account for any of the education gradient, and neither do personality factors such as a sense of control of oneself or over one's life.
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“this finding is supported by many studies showing that social determinants of health are key drivers of mortality,50, 51, 52, 53, 54”
From Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021 (2024) · cites this paper as [51]
In the citing paper
“the prevalence of several risk behaviors is generally higher among those with fewer than nine years of formal education, begins to decline among those who have nine to 12 years of formal education, and continues to decline with additional years of education”
From Education improves public health and promotes health equity (2015) · cites this paper as [28]
In the citing paper
“There is also strong evidence of a dose response between years of education and many health-related risk and protective behaviors among US adults.”
From Education improves public health and promotes health equity (2015) · cites this paper as [28]
In the citing paper
“Similar results are found by Cutler and Lleras-Muney,28 who use different sources to assess associations between educational attainment, health behaviors, and mortality in the United States and Great Britain.”
From Education improves public health and promotes health equity (2015) · cites this paper as [28]
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“Furthermore, education can enhance the acquisition of knowledge, values and priorities as well as the capacity to plan for the future and to allocate resources efficiently (Cutler & Lleras-Muney, 2010; Kenkel, 1991).”
BackgroundFood Deserts and the Causes of Nutritional Inequality*
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“Individuals of greater wealth and education enjoy better health not because of some process affecting the individual in 24 Interestingly, Maccini and Yang (2007) do not find evidence of this effect for men. isolation but rather because of the individual’s position in a social hierarchy.25 These theories posit that low…”
InfluentialSelf-citationReturns to Education: The Causal Effects of Education on Earnings, Health, and Smoking
Heckman, J. J., Humphries, J. E., & Veramendi, G. F. (2018) · Journal of Political Economy · doi:10.1086/698760 · Cited by 367
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The Causal Effect of Education on Health: What is the Role of Health Behaviors?
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“There is abundant evidence that a gradient exists (Cutler and Lleras-Muney, 2010).”
Non-Production Benefits of Education: Crime, Health, and Good Citizenship
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“Despite these findings, evidence by Kenkel (1991) and Cutler and Lleras-Muney (2010) suggests that differences in health-specific knowledge by education account for only small differences in behavior.”
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“Using the National Health Interview Surveys from 1990 to 2000, Cutler and Lleras-Muney (2010) estimated the health impacts of additional years of education (controlling for covariates).”
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“For instance, individuals with low educational attainment may have poorer health behaviors because they face different constraints, have different beliefs about the impact of their behavior, or have different norms than individuals with higher levels of education (Cutler & Lleras-Muney, 2010).”
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“Furthermore, education enhances the acquisition of knowledge, values and priorities as well as the capacity to plan for the future and efficiency in allocation of resources (Cutler and Lleras-Muney, 2010; Kenkel, 1991).”
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“…we include education as the best predictor included in our data that has been shown to strongly correlate with this behavior (see, e.g., Cutler and Lleras-Muney 2010).20 Then, we match to each spouse a measure of his or her underlying risk based on the predicted probability of a…”
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“Explanations for educational disparities in health and mortality typically point to the ways in which schooling provides individuals the agency and human capital to acquire resources and avoid risks for mortality (Cutler and Lleras-Muney 2010; Mirowsky and Ross 2003).”
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“At the individual level, it has been suggested that education increases individuals’ understanding of health issues, or at least that schooling improves skills that enable them to apply messages about health to their own lifestyles (Cutler and Lleras-Muney 2010).”
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“For example, it is well-known that education shows a strong empirical correlation with various health measures and mortality (Grossman 2006; Cutler and Lleras-Muney, 2010).”
BackgroundEconomic Growth, Globalisation and Beer Consumption
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Why Is Infant Mortality Higher in the United States than in Europe?
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Evaluating the 2014 sugar-sweetened beverage tax in Chile: An observational study in urban areas
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BackgroundEducational inequalities in longevity among OECD countries around 2016
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Oates, G. R., Jackson, B. E., Partridge, E. E., Singh, K., Fouad, M. N., & Bae, S. (2016) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2016.09.004 · Cited by 142
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“Among poor countries, education is associated with higher weight, but the relationship becomes negative as countries get richer and fatter (Cutler and Lleras-Muney 2014). Thus the effect of education depends on the stage of the “nutrition transition": in countries where nutrition levels are low and infectious disease…”
BackgroundSelf-citationThe Economics of Risky Health Behaviors
Cawley, J., & Ruhm, C. J. (2011) · National Bureau of Economic Research · doi:10.3386/w17081 · Cited by 140
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“We also know that there is an education gradient in health behaviors, and that this gradient is explained to some extent by differences in cognitive abilities (Cutler and Lleras-Muney 2010).”
BackgroundWhen does education matter? The protective effect of education for cohorts graduating in bad times
Cutler, D., Huang, W., & Lleras‐Muney, A. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.07.056 · Cited by 143
“Education is associated with overall better mental health and higher rates of health-promoting behaviors (Cutler and Lleras-Muney 2010b): we hypothesize this association is larger for those graduating in bad times.”
Self-citationBraakmann, N. (2011) · Journal of Health Economics · doi:10.1016/j.jhealeco.2011.05.015 · Cited by 131
Galama, T. J., Lleras‐Muney, A., & van Kippersluis, H. (2018) · National Bureau of Economic Research · doi:10.3386/w24225 · Cited by 128
Self-citationEducational Differences in Healthy Behavior Changes and Adherence Among Middle-aged Americans
Margolis, R. (2013) · Journal of Health and Social Behavior · doi:10.1177/0022146513489312 · Cited by 128
“E-mail: rachel.margolis@uwo.ca”
Early life exposure to malaria and cognition in adulthood: Evidence from Mexico
Venkataramani, A. S. (2012) · Journal of Health Economics · doi:10.1016/j.jhealeco.2012.06.003 · Cited by 129
The effect of college education on mortality
Buckles, K., Hagemann, A., Malamud, O., Morrill, M. S., & Wozniak, A. K. (2016) · Journal of Health Economics · doi:10.1016/j.jhealeco.2016.08.002 · Cited by 130
“However, there is substantial debate about whether these associations actually represent causal effects (see the reviews by Grossman, 2006, Cutler and Lleras-Muney, 2010, and Mazumder, 2012 ).”
BackgroundThe Economics of Risky Health Behaviors
Cawley, J., & Ruhm, C. J. (2011) · Handbook of health economics · doi:10.1016/b978-0-444-53592-4.00003-7 · Cited by 465
Kraft, P., & Kraft, B. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.05.019 · Cited by 141
Health Outcomes and Socio-economic Status Among the Elderly in China: Evidence from the CHARLS Pilot
Strauss, J., Lei, X., Park, A. F., Shen, Y. G., Smith, J. P., Yang, Z., & Zhao, Y. (2010) · Journal of Population Ageing · doi:10.1007/s12062-011-9033-9 · Cited by 128
“This view that the principal direction of causation flows almost exclusively from SES to health has been challenged (Cutler and Lleras-Muney 2010; Lleras-Muney 2005; Smith 1999; Strauss 1986, 1993; Strauss and Thomas 1995, 1998, 2008; Thomas and Strauss 1997; Thomas 2010).”
The developmental origins of health
Heckman, J. J. (2011) · Health Economics · doi:10.1002/hec.1802 · Cited by 116
Does schooling affect health behavior? Evidence from the educational expansion in Western Germany
Jürges, H., Reinhold, S., & Salm, M. (2011) · Economics of Education Review · doi:10.1016/j.econedurev.2011.04.002 · Cited by 122
The Effect of Education on Adult Health and Mortality: Evidence from Britain
Clark, D., & Royer, H. (2010) · National Bureau of Economic Research · doi:10.3386/w16013 · Cited by 121
“Among those with exactly a high school degree, the analogous figure was 14.4 percent.3 As shown by Banks et al. (2006) and Cutler & Lleras-Muney (2007), similar patterns can be found in the UK.”
BackgroundInfluentialSmith, J. P., Strauss, J. A., & Zhao, Y. (2014) · The Journal of the Economics of Ageing · doi:10.1016/j.jeoa.2014.08.006 · Cited by 114
Zhao, W., Ammous, F., Ratliff, S., Liu, J., Yu, M., Mosley, T. H., Kardia, S. L. R., & Smith, J. A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16173141 · Cited by 113
Silins, E., Fergusson, D. M., Patton, G. C., Horwood, L. J., Olsson, C. A., Hutchinson, D. M., Degenhardt, L. J., Tait, R. J., Borschmann, R., Coffey, C., et al. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.08.034 · Cited by 117
The socioeconomic gradient in physical inactivity: Evidence from one million adults in England
Farrell, L., Hollingsworth, B. P., Propper, C., & Shields, M. A. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.10.039 · Cited by 112
“Individuals who are better educated may also be more aware of the consequences of inactivity and bettermotivated to overcome the changes brought about by technological change (Cutler and Lleras-Muney, 2010).”
BackgroundCorsi, D. J., Boyle, M. H., Lear, S. A., Chow, C. K., Teo, K. K., & Subramanian, S. V. (2013) · Cancer Causes & Control · doi:10.1007/s10552-013-0307-9 · Cited by 115
A Theory of Socio-economic Disparities in Health over the Life Cycle
Galama, T. J., & van Kippersluis, H. (2018) · The Economic Journal · doi:10.1111/ecoj.12577 · Cited by 126
“Plausibly, this represents the dominant effect,25 consistent with wealthy individuals behaving healthier (e.g., Cutler and Lleras-Muney, 2010; Cutler, Lleras-Muney and Vogl, 2011; Cawley and Ruhm, 2012), and consistent with less affluent individuals responding more strongly to an unanticipated…”
Does more education lead to better health habits? Evidence from the school reforms in Australia
Li, J., & Powdthavee, N. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.07.021 · Cited by 118
Deaths of Despair in Comparative Perspective
KING, L. P., Scheiring, G., & Nosrati, E. (2022) · Annual Review of Sociology · doi:10.1146/annurev-soc-030320-031757 · Cited by 110
Cannabis Use and Suicidal Ideation
OURS, J. C. V., Williams, J., Fergusson, D. M., & Horwood, L. J. (2012) · Journal of Health Economics · doi:10.1016/j.jhealeco.2013.02.002 · Cited by 103
“Given the enduring impact of education on health, the deficits induced non-fatal suicidal behaviors in youth are likely to have a long lived and cumulative impact on lifetime health and wellbeing (Cutler and Lleras-Muney, 2010).”
BackgroundHealth, Height, Height Shrinkage, and SES at Older Ages: Evidence from China()
Huang, W., Lei, X., Ridder, G., Strauss, J., & Zhao, Y. (2013) · PubMed Central · doi:10.1257/app.5.2.86 · Cited by 103
Metadata
- Authors
- Cutler, D. M., & Lleras-Muney, A.
- Affiliations
- National Bureau of Economic Research (US)
- ORCID
- Cutler, David M.
- Venue
- Journal of Health Economics
- Publisher
- Elsevier BV
- Published
- 2010-01
- Volume
- 29
- Issue
- 1
- Pages
- 1-28
- ISSN
- 0167-6296 (ISSN-L)
- PMC
- PMC2824018
- OpenAlex
- W2164662768
- Cited by
- 1,920
- References
- 72
- Citations by year
- 2026: 137 · 2025: 153 · 2024: 120 · 2023: 124 · 2022: 142 · 2021: 142 · 2020: 139 · 2019: 130 · 2018: 130 · 2017: 119 · 2016: 101 · 2015: 127 · 2014: 121 · 2013: 79 · 2012: 79
- FWCI
- 52.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Health Economics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Institute on Aging (P01AG005842)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD041022)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Sociology and Political Science › Intergenerational and Educational Inequality Studies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- education gradient, health behavior, income, health insurance, family background, health knowledge, cognitive ability, social networks, risk aversion, discounting, perceived control, cross-national comparison
- MeSH terms
- Adult, Educational Status, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, United States, Health Behavior, Databases, Factual, Risk Reduction Behavior
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