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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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“The effects of the infant intervention on longevity may include a behavioural component over and above biological mechanisms to the extent that infant health improvements raise cognitive capacity, adult education and income (Almond and Currie, 2011b), and education and income are effective in averting and treating mor…”
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“Perhaps most closely related is the work of De Walque (2009), which highlights trends in the relationship between education, HIV status and knowledge in five African countries.”
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“Similarly, for education, we are not aware of generalizable spatial patterns in educational attainment, but the literature makes it clear that education is an important predictor of well-being and socioeconomic status (Cutler and Lleras-Muney 2010).”
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“, no smoking, physical activity, drinking in moderation) as well as access to resources that lead to greater perceived health and physical functioning in addition to lower levels of morbidity and mortality compared to individuals with less years of education [8, 9].”
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“Education enters the model as it has been shown to have a causal effect on health (Conti et al 2010) and health behaviours (Cutler and Lleras-Muney 2010), with higher education contributing to better health.”
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Xie, S., & Mo, T. (2014) · China Economic Review · doi:10.1016/j.chieco.2013.12.003 · Cited by 65
Lei, X., Sun, X., Strauss, J. A., Zhao, Y., Yang, G., Hu, P., Hu, Y., & Yin, X. (2014) · The Journal of the Economics of Ageing · doi:10.1016/j.jeoa.2014.10.001 · Cited by 71
“This view, that the principal direction of causation flows almost exclusively from SES to health, has been challenged (Lleras-Muney, 2005; Cutler and Lleras-Muney, 2010a; Smith, 1999; Strauss, 1986, 1993; Strauss and Thomas, 1995,1998, 2008; Thomas and Strauss, 1997; Thomas, 2010).”
BackgroundResultSmith, W. C., Anderson, E. W., Salinas, D., Horvatek, R., & Baker, D. P. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.10.027 · Cited by 67
Andersson, M. A., & Harnois, C. E. (2019) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112780 · Cited by 66
Ulph, F., Cullinan, T., Qureshi, N., & Kai, J. (2014) · European Journal of Human Genetics · doi:10.1038/ejhg.2014.126 · Cited by 66
Healthy(?), wealthy, and wise: Birth order and adult health
Black, S. E., Devereux, P. J., & Salvanes, K. G. (2016) · Economics & Human Biology · doi:10.1016/j.ehb.2016.06.005 · Cited by 66
The impact of socioeconomic position (SEP) on women's health over the lifetime
O'Neil, A. E., Russell, J. D., Thompson, K., Martinson, M. L., & Peters, S. A. E. (2020) · Maturitas · doi:10.1016/j.maturitas.2020.06.001 · Cited by 65
“Women with higher education levels tend to be more likely to engage in health-promoting behaviours [43].”
The health effects of leaving school in a bad economy
Maclean, J. C. (2013) · Journal of Health Economics · doi:10.1016/j.jhealeco.2013.07.003 · Cited by 65
Legleye, S., Khlat, M., Beck, F., & Peretti‐Watel, P. (2011) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2011.02.004 · Cited by 65
The Relationship between Health and Schooling: What's New?
Grossman, M. B. (2015) · Nordic Journal of Health Economics · doi:10.5617/njhe.2362 · Cited by 65
Bosque‐Mercader, L., & Siciliani, L. (2022) · The European Journal of Health Economics · doi:10.1007/s10198-022-01464-8 · Cited by 64
“We follow the approach of Cutler & Lleras-Muney [37], who decomposed the health and education gradient.”
MethodWiradnyani, L. A. A., Khusun, H., Achadi, E. L., Ocviyanti, D., & Shankar, A. H. (2016) · Public Health Nutrition · doi:10.1017/s1368980016001002 · Cited by 77
Aitsi-Selmi, A., Bell, R., Shipley, M. J., & Marmot, M. G. (2014) · PLoS ONE · doi:10.1371/journal.pone.0090403 · Cited by 67
Does academic achievement during childhood and adolescence benefit later health?
Lê-Scherban, F., Diez Roux, A. V., Li, Y., & Morgenstern, H. (2014) · Annals of Epidemiology · doi:10.1016/j.annepidem.2014.02.008 · Cited by 65
Park, C. L., Cho, D., & Moore, P. J. (2018) · Psychology and Health · doi:10.1080/08870446.2018.1510932 · Cited by 64
“The independent effects of education on health behaviours have been demonstrated in prior research (e.g. Cutler & Lleras-Muney, 2010; Rhodes et al., 2012), although few studies have specifically isolated the effects of education by comprehensively controlling for key confounding variables such as…”
BackgroundHeterogeneity in Marginal Non-Monetary Returns to Higher Education
Kamhöfer, D. A., Schmitz, H., & Westphal, M. (2015) · Journal of the European Economic Association · doi:10.1093/jeea/jvx058 · Cited by 69
Changing the Odds for Vulnerable Children
OECD (2019) · OECD eBooks · doi:10.1787/a2e8796c-en · Cited by 88
School quality and the education–health relationship: Evidence from Blacks in segregated schools
Frisvold, D., & Golberstein, E. (2011) · Journal of Health Economics · doi:10.1016/j.jhealeco.2011.08.003 · Cited by 66
The Geography of Poverty and Nutrition: Food Deserts and Food Choices Across the United StatesPreprint
Allcott, H., Diamond, R., & Dubb, J.-P. M. (2018) · SSRN Electronic Journal · doi:10.2139/ssrn.3095779 · Cited by 62
Conti, G., & Hansman, C. (2012) · Journal of Health Economics · doi:10.1016/j.jhealeco.2012.07.005 · Cited by 61
Influences underlying family food choices in mothers from an economically disadvantaged community
Hardcastle, S. J., & Blake, N. (2015) · Eating Behaviors · doi:10.1016/j.eatbeh.2015.11.001 · Cited by 62
Twin Birth and Maternal Condition
Bhalotra, S. R., & Clarke, D. (2018) · The Review of Economics and Statistics · doi:10.1162/rest_a_00789 · Cited by 62
“Since education is also widely available and we have seen it is predictive of twinning (both conditional and unconditional on maternal health), below we present plots displaying systematically positive education differences between twin and non-twin mothers in all countries in the sample (Figure A5) and just as for he…”
BackgroundResultYoung People Are the Front Lines of Financial Inclusion: A Review of 45 Years of Research
Friedline, T. L., & Rauktis, M. E. (2014) · Journal of Consumer Affairs · doi:10.1111/joca.12050 · Cited by 60
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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