hi all,
 
a couple of quick thoughts on this..
 
length of education is a marker of class status.. and of the generosity of the state (and its tax payers)
 
the use of education is as a credential and as a road to more opportunities
 
what happens when more and more people are educated to a greater and greater degree?  i suspect there remains a relative power differential between those educated the most, and those the least.
 
more education will help, but we still have to change the power dynamics of our current social system..
 
ken

________________________________

From: Social Determinants of Health on behalf of Joel Moskowitz
Sent: Wed 1/3/2007 2:27 PM
To: [log in to unmask]
Subject: [SDOH] A Surprising Secret to a Long Life: Stay in School



A Surprising Secret to a Long Life: Stay in School

Gina Kolata, New York Times, Jan 3, 2007

James Smith, a health economist at the RAND
Corporation, has heard a variety of hypotheses
about what it takes to live a long life ­ money,
lack of stress, a loving family, lots of friends. But he has been a skeptic.

Yes, he says, it is clear that on average some
groups in every society live longer than others.
The rich live longer than the poor, whites live
longer than blacks in the United States.
Longevity, in general, is not evenly distributed
in the population. But what, he asks, is cause
and what is effect? And how can they be disentangled?

He is venturing, of course, into one of the
prevailing mysteries of aging, the persistent
differences seen in the life spans of large
groups. In every country, there is an average
life span for the nation as a whole and there are
average life spans for different subsets, based
on race, geography, education and even churchgoing.

But the questions for researchers like Dr. Smith
are why? And what really matters?

The answers, he and others say, have been a
surprise. The one social factor that researchers
agree is consistently linked to longer lives in
every country where it has been studied is
education. It is more important than race; it
obliterates any effects of income.

Year after year, in study after study, says
Richard Hodes, director of the National Institute
on Aging, education "keeps coming up."

And, health economists say, those factors that
are popularly believed to be crucial ­ money and
health insurance, for example, pale in comparison.

Dr. Smith explains: "Giving people more Social
Security income, or less for that matter, will
not really affect people's health. It is a good
thing to do for other reasons but not for health."

Health insurance, too, he says, "is vastly overrated in the policy debate."

Instead, Dr. Smith and others say, what may make
the biggest difference is keeping young people in
school. A few extra years of school is associated
with extra years of life and vastly improved health decades later, in old age.

It is not the only factor, of course.

There is smoking, which sharply curtails life
span. There is a connection between having a
network of friends and family and living a long
and healthy life. And there is evidence that
people with more powerful jobs and, presumably,
with more control over their work lives, are healthier and longer lived.

But there is little dispute about the primacy of education.

"If you were to ask me what affects health and
longevity," says Michael Grossman, a health
economist at the City University of New York, "I
would put education at the top of my list."

Graduate Student Finds Answer

The first rigorous effort to decide whether
education really changes people so they live
longer began in a most inauspicious way.

It was 1999 and a Columbia University graduate
student, Adriana Lleras-Muney, was casting about
for a topic for her doctoral dissertation in
economics. She found an idea in a paper published
in 1969. Three economists noted the correlation
between education and health and gave some
advice: If you want to improve health, you will
get more return by investing in education than by investing in medical care.

It had been an inflammatory statement, Dr.
Lleras-Muney says. And for good reason. It could
only be true if education in and of itself caused good health.

But there were at least two other possibilities.

Maybe sick children did not go to school, or
dropped out early because they were ill. Or maybe
education was a proxy for wealth, and it was
wealth that led to health. It could be that
richer parents who gave their children
everything, including better nutrition, better
medical care and a better education, had children
who, by virtue of being wealthy, lived longer.

How, she asked herself, could she sort out causes
and effects? It was the chicken-and-egg problem that plagues such research.

The answer came one day when Dr. Lleras-Muney was
reading another economics paper. It indicated
that about 100 years ago, different states
started passing laws forcing children to go to
school for longer periods. She knew what to do.

"The idea was, when a state changed compulsory
schooling from, say, six years to seven years,
would the people who were forced to go to school
for six years live as long as the people the next
year who had to go for seven years," Dr. Lleras-Muney asked.

All she would have to do was to go back and find
the laws in the different states and then use
data from the census to find out how long people
lived before and after the law in each state was changed.

"I was very excited for about three seconds," she
says. Then she realized how onerous it could be
to comb through the state archives.

But when her analysis was finished, Dr.
Lleras-Muney says, "I was surprised, I was really
surprised." It turned out that life expectancy at
age 35 was extended by as much as one and a half
years simply by going to school for one extra year.

Her prize-winning paper appeared in Review of
Economic Studies. And she ended up with a job as
an assistant professor at Princeton. Now, others
papers have appeared, examining the effects of
changed laws on compulsory education in Sweden,
Denmark, England and Wales. In every country,
compelling children to spend a longer time in school led to better health.

"You might think that forcing someone to go to
school who does not want to be there may not be
the same thing as going to school because you
want to," Dr. Lleras-Muney said. "That did not seem to be the case."

Not everyone was convinced.

Victor Fuchs, a health economist at Stanford,
points out that it is not clear how or why
education would lead to a longer life.

And, he said, there are other mysteries. For
example, women increased their years of schooling
more than men have in recent decades. But men are
catching up with women in their life spans.

And it might be expected that after a certain
point, more years of school would not add to a
person's life span. That, however, is not what
the data shows. The education effect never wanes.
But most researchers say they are swayed by Dr.
Lleras-Muney's work and the studies in other
countries. That, though, leaves the question of
why the education effect occurs.

Dr. Lleras-Muney and others point to one
plausible explanation ­ as a group, less educated
people are less able to plan for the future and
to delay gratification. If true, that may, for
example, explain the differences in smoking rates
between more educated people and less educated ones.

Smokers are at least twice as likely to die at
any age as people who never smoked, says Samuel
Preston, a demographer at the University of
Pennsylvania. And not only are poorly educated
people more likely to smoke but, he says,
"everybody knows that smoking can be deadly," and
that includes the poorly educated.

But education, Dr. Smith at RAND finds, may
somehow teach people to delay gratification. For
example, he reported that in one large federal
study of middle-aged people, those with less
education were less able to think ahead.

"Most of adherence is unpleasant," Dr. Smith
says. "You have to be willing to do something
that is not pleasant now and you have to stay
with it and think about the future."

He deplores the dictums to live in the moment or
to live for today. That advice, Dr. Smith says,
is "the worst thing for your health."

An Observation on the Street

In the late 1970's, Lisa Berkman, now a professor
of public policy at the Harvard School of Public
Health, took a part-time job at a San Francisco
health care center. It drew people from Chinatown
and the city's Italian neighborhood, North Beach,
as well as from the Tenderloin district, a poor
area where homeless people lived on the streets
and mentally ill people roamed. And she noticed something striking.

"In Chinatown and North Beach, there were these
tightly bound social networks," Dr. Berkman
recalls. "You saw old people with young people.
In the Tenderloin, people were just sort of
dumped. People were really isolated and did not
have ways of figuring out how to make things work."

A few years later, she was haunted by that
observation. She had entered graduate school and
was studying Seventh-day Adventists when she
began to wonder whether the standard explanation
for their longer lives ­ a healthy, vegetarian diet ­ was enough.

"They were at decreased risk from many, many
diseases, even ones where diet was not
implicated," Dr. Berkman says. And, she adds, "it
seemed they simply had a slower rate of aging."

Seventh-day Adventists, like the people in
Chinatown and North Beach, had "incredibly
cohesive social networks," Dr. Berkman notes. Could that be the clue?

Thirty years later, studies have borne out her hunch.

The risks of being socially isolated are
"phenomenal," Dr. Berkman says, associated with
twofold to fivefold increases in mortality rates.
And the correlations emerged in study after study
and in country after country.

Yet, Dr. Berkman adds, there was that perennial
question: Did social isolation shorten lives or
were people isolated because they were sick and
frail and at great risk of death?

She knows that sometimes ill health leads to
social isolation. But, Dr. Berkman says, the more
she investigated, the more evidence she found
that social isolation might also lead to poor
health and a shorter life by, for example,
increasing stress and making it harder to get assistance when ill.

But researchers also warn that their findings
that education and, to a lesser degree, social
networks, may directly affect health do not
necessarily mean that other hypotheses would also
hold up. The cautionary tale, health economists
say, is the story of the link between health and wealth.

Over and over again, studies show that health is
linked to wealth. It even matters where a person lives.

For example, in a new analysis of Medicare
beneficiaries, Stephanie Raymond and Kristen
Bronner of Dartmouth College find that the lowest
death rates are in the wealthiest places. So in
San Francisco, with a per capita income of
$57,496, just 4.16 percent of Medicare
beneficiaries die each year. But in Tuscaloosa,
Ala, whose per capita income is $24,257, the
annual death rate was 5.97 percent.

Race was not a large factor.

"If you control for where people live, the
disparities between black and white mortality
rates become much smaller," said Jonathan
Skinner, a Dartmouth health economist.

An obvious explanation is that wealth buys
health. And it seems plausible. Poorer people, at
least in the United States, are less likely to
have health insurance or access to medications.

But Dr. Fuchs says, then why don't differences
between rich and poor shrink in countries where everyone has health care?

"All you have to do is look at the experience of
countries like England that have had health
insurance for more than 40 years," he says.
"There is no diminution in the class
differentials. It's been the same in Sweden. It's true everywhere."

In fact, Dr. Smith says, the wealth-health
connection, at least among adults, goes in the
wrong direction. It is not that lower incomes
lead to poor health so much as that poor health
leads to lower incomes, he found.

A Skewing of the Numbers

Sick people tend to have modest out-of-pocket
medical expenses, but often are unable to work or unable to work full time.

The result can be a drastic and precipitous and
long-lasting drop in income. As the ranks of
middle- and upper-income populations become
depleted of people who are ill, there is a
skewing of the data so healthy people are disproportionately richer.

That effect emerged when Dr. Smith analyzed data
from the National Institute on Aging's National
Health and Retirement Survey, a national sample
of 7,600 American households with at least one person aged 51 to 61.

If someone developed cancer, heart disease or
lung disease ­ which will affect about a fifth of
people aged 51 to 61 over the next eight years ­
the household's income declined by an average of
more than $37,000. And its assets ­ its wealth ­
fell by $49,000 over the ensuing eight years,
even though out-of-pocket medical expenses were just $4,000.

Dr. Smith also asked whether getting richer made
people healthier, an effect that could translate
into a longer life. It does not, he concluded
after studying the large increases in income
during the stock market surge of the 1990s.

"I find almost no role of financial anything in
the onset of disease," Dr. Smith says. "That's an
almost throw-you-out-of-the-room thing," he
confesses, but the data, he and other economists insist, is consistent.

Income, says Dr. Preston, "is so heavily influenced by health itself."

Much More Than Genes and Luck

As director of the National Institute on Aging,
Dr. Hodes often speaks to policy makers, giving
briefings on the latest scientific findings. But,
he and others say, all too often there is a disconnect.

There are some important findings: Health and
nutrition early in life, even prenatally, can
affect health in middle and old age and can affect how long people live.

For the most part, genes have little effect on
life spans. Controlling heart disease risk
factors, like smoking, cholesterol, blood
pressure and diabetes, pays off in a more
vigorous old age and a longer life. And it seems
increasingly likely that education plays a major role in health and life spans.

And then there is the question of what to do. It
might seem logical to act now, pouring money into
education or child health, for example.

But scientists often say they would like good
evidence beforehand that a program that sounds
like it would make a difference, like keeping
students in school longer, really works. And if
the goal is longer and healthier lives, is that
the most cost-effective way to spend public money?

There are just so many questions remaining, says
Richard Suzman, a program director at the
National Institute on Aging. Even studies showing
that, for many people, the die may be cast early
in life, do not reveal how best to make changes.

"We have only a vague idea of when and where
early experience links to old age or when and
where to intervene," Dr. Suzman says.

"When it comes to changing things," says Dr.
Skinner, the Dartmouth economist, "we are in uncharted territory."

-------------------
Problems/Questions? Send it to Listserv owner: [log in to unmask]


To unsubscribe, send the following message in the text section -- NOT the subject header --  to [log in to unmask]

SIGNOFF SDOH

DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU.

To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header.

SUBSCRIBE SDOH yourfirstname yourlastname

To post a message to all 1200+ subscribers, send it to [log in to unmask]
Include in the Subject, its content, and location and date, if relevant.

For a list of SDOH members, send a request to [log in to unmask]

To receive messages only once a day, send the following message to [log in to unmask]
SET SDOH DIGEST

To view the SDOH archives, go to: https://listserv.yorku.ca/archives/sdoh.html

-------------------
Problems/Questions? Send it to Listserv owner: [log in to unmask]


To unsubscribe, send the following message in the text section -- NOT the subject header --  to [log in to unmask]

SIGNOFF SDOH

DO NOT SEND IT BY HITTING THE REPLY BUTTON. THIS SENDS THE MESSAGE TO THE ENTIRE LISTSERV AND STILL DOES NOT REMOVE YOU.

To subscribe to the SDOH list, send the following message to [log in to unmask] in the text section, NOT in the subject header.

SUBSCRIBE SDOH yourfirstname yourlastname

To post a message to all 1200+ subscribers, send it to [log in to unmask]
Include in the Subject, its content, and location and date, if relevant.

For a list of SDOH members, send a request to [log in to unmask]

To receive messages only once a day, send the following message to [log in to unmask]
SET SDOH DIGEST

To view the SDOH archives, go to: https://listserv.yorku.ca/archives/sdoh.html