Cited by 772Public Health Policies and EducationHealth disparities and outcomesPublic Health and Social Inequalities

The DOI matches its Crossref record; 59 of the 61 references it cites were found in a registry or an index; none of the 69 sources its claims cite is checked for support yet.

Education Improves Public Health and Promotes Health Equity

Open access
Hahn, Robert A., Truman, Benedict I.·2015·International Journal of Health Services

Abstract

This article describes a framework and empirical evidence to support the argument that educational programs and policies are crucial public health interventions. Concepts of education and health are developed and linked, and we review a wide range of empirical studies to clarify pathways of linkage and explore implications. Basic educational expertise and skills, including fundamental knowledge, reasoning ability, emotional self-regulation, and interactional abilities, are critical components of health. Moreover, education is a fundamental social determinant of health – an upstream cause of health. Programs that close gaps in educational outcomes between low-income or racial and ethnic minority populations and higher-income or majority populations are needed to promote health equity. Public health policy makers, health practitioners and educators, and departments of health and education can collaborate to implement educational programs and policies for which systematic evidence indicates clear public health benefits.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

Hahn argues that education is both a core component of health and a causal social determinant, and that educational programs and policies should be treated as public health interventions to promote health equity. The paper synthesizes observational, quasi-experimental, and experimental evidence linking educational attainment to health behaviors, income, morbidity, mortality, and life expectancy.

Key findings

  • Education is conceptualized as a personal attribute including knowledge, reasoning, emotional self-regulation, and interactional skills; it is both an element and a cause of health, operating through psychosocial environment, work/income, and healthy behavior pathways.
  • In US adults, those with less than a high school education are 2.4 times as likely as high school graduates and 4.1 times as likely as those with post-secondary education to rate their health as poor, after controlling for demographics and income. At age 25 in 2005, men with less than high school could expect 44.2 additional years (to age 69.2), while men with a graduate degree could expect more than 15 years longer; women with less than high school could expect to live to 74.9, while women with a graduate degree could expect more than 11 years longer.
  • Quasi-experimental compulsory schooling evidence indicates each additional required year reduced mortality by 3.6% over 10 years and gained 1.7 years of life expectancy at age 35. Early childhood experiments found Perry Preschool participants at age 40 had more chronic diseases but fewer deaths; Abecedarian participants by mid-30s had more favorable cardiovascular risk profiles, particularly males; Chicago Child-Parent Center participants at age 24 had lower out-of-home placement, violent arrests/convictions, and disability.
  • Estimated annual deaths attributable to lack of high school education among US adults aged 25–64 were 237,410, exceeding smoking-attributable deaths among ages 35–64 at 163,500. The economic value of health forgone in 2006 by US adults without a college education was estimated at US$1.02 trillion per year, 7.7% of GDP; each high school dropout completing high school was estimated to yield a lifetime benefit of US$209,000, with cost–benefit ratios of 1.5 to 3.5 for five programs.

Methods

  • Design: conceptual and review article that develops a framework and reviews empirical evidence; it uses Bradford-Hill criteria to assess causal association between education and health.
  • Data/sample: cites observational cohort studies with concurrent controls, natural quasi-experiments in education policy, and educational experiments, including Perry Preschool, Carolina Abecedarian, Chicago Child-Parent Center, Lleras-Muney compulsory schooling analyses, Ross and Wu national probability samples, and Link et al. two US cohorts.
  • Analysis: narrative synthesis and a conceptual pathway model linking education to health through psychosocial environment, work, and healthy behavior; no new primary data collection or systematic meta-analysis is reported.

Limitations

  • Stated in paper: the focus is formal education measured in most research; education measures are problematic, including years of schooling, school completion, standardized tests, and teacher-assigned grades; true experiments in education are uncommon; and the relative contribution of pathway covariate groups cannot be determined precisely because the groups are unlikely to be causally independent and order of entry affects coefficients.
  • Stated in paper: the literature is extensive but only a few examples are described; some estimates come from an unpublished manuscript and older data; specificity is an exception among Bradford-Hill criteria because education and its consequences are broad and heterogeneous.
  • Evident from text: this is not a systematic review or meta-analysis, so example selection may not be exhaustive; causal inference from observational and quasi-experimental evidence remains subject to confounding, although the paper argues the Bradford-Hill criteria support causation.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1177/0020731415585986

Cites

59 of 59 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

59 Not checked yet · 21 Own interpretation · 1 No basis given

Verify all 69 references — free account

Show all 45 claims

  • It may state two separate claims as one. 26
  • Probably not a substantial claim. 12
36 of 36
  • The paper relies on this without support.

    The modal age for completing formal education in the United States is in the mid-20s and substantially precedes the peak age for mortality in the United States at 77 years of age.

    “In addition, the modal age for completing formal education (the mid-20 s) substantially precedes the peak age for mortality in the United States (77 years of age) by many years, consistent with another Bradford-Hill principle, ie, the precedence of cause before effect.”
  • The paper relies on this without support.

    Formal education is the aspect of education that is measured in most research.

    “Although we conceive of education broadly, including both its formal and informal sources, the focus of our evidence review is the formal education that is measured in most research.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

2 of 2

Citations

Cites

Show all 61 references

Research works printed but not linked: 10

  1. Dewey J, 1916, Democracy and Education: An Introduction to the Philosophy of Education
  2. Egerter S, 2009, Educ Health, 6, 1
  3. National Commission on Excellence in Education, 1983, A Nation at Risk
  4. Sadana R, 2002, Describing population health in six domains: comparable results from 66 household surveys. Global Programme on Evidence for Health Policy. Discussion Paper No. 43
  5. U.S. Congress, Office of Technology Assessment, 1992, Testing in American Schools: Asking the Right Questions, OTA-SET-519
  6. Physical Activity Guidelines Advisory Committee, 2008, Physical Activity Guidelines Advisory Committee Report
  7. Powell KE, 1986, Public Health Rep, 101, 15
  8. Schiller JS, 2012, Vital Health Stat, 10, 1
  9. CDC National Center for Health Statistics, 2009, Health, United States, 2008
  10. Rudolph L, 2013, Health in All Policies: A Guide for State and Local Governments

Cited by

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Items 501–600 of 772

Metadata

Authors
Hahn, R. A., & Truman, B. I.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Hahn, Robert A.
Venue
International Journal of Health Services
Published
2015-05-19
Volume
45
Issue
4
Pages
657-678
ISSN
  • 0020-7314 (ISSN-L)
  • 1541-4469
OpenAlex
W2139080455
Cited by
755
References
61
Citations by year
2026: 52 · 2025: 79 · 2024: 89 · 2023: 115 · 2022: 96 · 2021: 110 · 2020: 120 · 2019: 64 · 2018: 16 · 2017: 6 · 2016: 4 · 2015: 2
FWCI
17.03
Type
journal article
Language
en
Open access
Locations
  • International Journal of Health Services (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (CC999999)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Public Health Policies and Education
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
education and health, health equity, social determinants of health, educational intervention, education policy, educational attainment gap, low-income populations, racial and ethnic minorities, emotion regulation, educational skills, public health interventions
MeSH terms
Health Equity, Adult, Educational Status, Female, Health Status, Humans, Male, Middle Aged, Morbidity, Public Health, Risk Factors, Socioeconomic Factors, Health Behavior, Social Determinants of Health

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