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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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“Education is an important marker because it may help people to develop cognitive skills that would enable them to understand and act upon new health information (Rosenzweig 1995; Mirowsky and Ross 2003; Cutler and Lleras-Muney 2010).”
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“As education is a major determinant of health behaviours, and especially of smoking [23], we considered the highest level of education as a control variable.”
BackgroundAn economic perspective on the causal explanations for the socioeconomic inequalities in health
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“For example, Cutler and Lleras-Muney (2010) find that more educated people are more likely to exercise, seek preventive care, and to control their blood pressure.”
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“Health-related behaviors more generally, which can impact life expectancy and health outcomes, associate with health literacy (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011) and education level (Cutler & Lleras-Muney, 2010).”
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“The rationale was to increase vocational performance and reduce student drop-out as evidence shows that health and wellbeing are correlated with drop-out and later work capacity in the labour market [25].”
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“and UK data, cognitive ability stemming from greater education rather than as a latent trait explained 5–30% of the education gradient for a range of health behaviors, including smoking, obesity, and heavy drinking.(40) Locus of control has been associated with greater well-being, and individuals with higher socioecon…”
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“Education affords a range of direct and indirect benefits that promote longer and healthier lives (Cutler and Lleras-Muney 2010; Hummer and Hernandez 2013; Mirowsky and Ross 2003; Warren et al. 2004) and stratify health lifestyles (Pampel et al. 2010).”
BackgroundEducational Attainment and Health Behaviors Among Young Adult Men: Racial/Ethnic Disparities
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“As educational attainment influenced both dimensions, education may be one of the most important factors for individuals to sustain a healthy life (Cutler & Lleras-Muney, 2010; Teixidó-Compañó et al., 2018).”
BackgroundResultInfluentialReasons to attend college, academic success, and post-college plans
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“, those with a high school degree or less) are most likely to get their information from a doctor [40].”
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The impact of recession on drinking and smoking behaviours in Canada
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“previously been considered as important determinants of health behavior [23, 24] as well as of how individuals obtain health information [25].”
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A Theory of Education and Health
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“This educational difference could be explained by the highly text-based feedback that was provided in the intervention, which may be better processed by high-educated people (Cutler & Lleras-Muney, 2010).”
Lowry, E., Rautio, N., Karhunen, V., Miettunen, J., Ala‐Mursula, L., AUVINEN, J. P., Keinanen-Kiukaanniemi, S. M., Puukka, K. S., Prokopenko, I., Herzig, K., et al. (2018) · International Journal of Obesity · doi:10.1038/s41366-018-0175-1 · Cited by 13
Educational differences in the compression of disability incidence in the United States
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What we learn in school: Cognitive and non-cognitive skills in the educational production function
Garcia, G. (2013) · Columbia Academic Commons (Columbia University) · doi:10.7916/d8ff40kp · Cited by 14
“Lleras-Muney (2005) and Cutler and Lleras-Muney (2010) explain three potential channels through which education and health could be connected: more educated people make better decisions (less riskier) regarding their health because they have better information; poorer health may impari education…”
BackgroundWealth and Health Behavior: Testing the Concept of a Health CostPreprint
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Alcohol Exposure In Utero and Child Academic Achievement
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Is Smoking Inferior? Evidence from Variation in the Earned Income Tax CreditPreprint
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“As education is a major determinant of health behaviours [17], we considered the highest level of education as a control variable.”
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A Multidimensional Approach to Understanding Food Deserts in Vulnerable Contexts
Cruz-Piedrahita, C., Martinez-Carranza, F.-J., & Delgado-Serrano, M. D. M. (2024) · Sustainability · doi:10.3390/su16031136 · Cited by 14
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School starting age and long‐run health in the United States
Arnold, G. E., & Depew, B. (2018) · Health Economics · doi:10.1002/hec.3810 · Cited by 13
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“A smaller set of studies has identified the mechanisms underlying the link between formal education and health outcomes (Ross and Mirowsky, 1999; Cutler and Lleras-Muney, 2010; Vogl, 2014).”
BackgroundInfluential
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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