Learn - to live longer

June 18, 2004

Access to higher education can be a big factor in enjoying a healthy life, says Michael Marmot

With all the talk around the Higher Education Bill, it is worth remembering that among the benefits of education may be its possible health effects. In my book Status Syndrome , I posed the question: "Why should educated people with good stable jobs have a higher risk of dropping dead than people with a bit more education and slightly higher-status jobs?" Do small increments of education really matter so much?

They appear to. The Swedish sociologist Robert Erikson showed that people with a PhD had longer life expectancy than people with a masters degree or professional education. They, in turn, could expect longer lives than graduates with a bachelors, and so on down the hierarchy.

There are several ways to interpret this finding. Let's focus on two. If more people had masters degrees or PhDs, their health would improve.

Conclusion: widen access to higher education and, in particular, second degrees. Alternatively, Erikson's findings could be part of the more general status-syndrome phenomenon. However it is defined, there will be social hierarchies and these will be related to differences in health.

Conclusion: widening access will make no difference to length of life since the social hierarchy will emerge in a different way, for example, in whether you were at an elite university or not; it is position in the hierarchy that is important.

It may not seem possible, but both conclusions are correct. Education matters, but so does position in the hierarchy. Asking why education matters for health can help us to understand what we want out of our educational system. The link is subtle, which makes it fairly easy to rule out health literacy as an explanation: it cannot be that people with PhDs have 50 per cent lower mortality than those with "only" a masters because the PhDs are so much better at reading product labels or health news.

Besides, we see gradients in health in non-human primates whose level of health literacy is shockingly poor.

Two other explanations are relevant to the question of what we want from education. A body of evidence from humans and non-human primates suggests that place in the hierarchy is closely linked with the ability and opportunity to satisfy deep human needs. Crucial among these are the ability to exert control over one's life and to have opportunities for full engagement in society. For example, in the Whitehall II study that I am leading, we have shown that British civil servants with low control over their work had higher risk of coronary heart disease, mental illness, back pain and sickness absence than those with more control. A wealth of studies shows that low social supports are related to increased risk of illness and of death.

Education, then, may improve health both because it leads to higher positions in the hierarchy and because it is likely to arm people with what they need to exert more control over their lives and to participate fully in society.

As a second explanation, we should also ask whether it is the PhD degree which ensured better health, or if the person who got the PhD was both destined for a PhD and better health. This brings us back to early life. As a university teacher, I am rightly exercised by what is happening in our universities. The evidence shows, however, that the social gradient in health is affected not only by what people experience in adult life but by earlier life experiences. The strong relation between parental background and children's performance in schools suggests that the right time to intervene to start to reduce the effects of status on health is in early childhood.

But if I had to choose between investing in early childhood development or university education, I'd say spend less on defence or raise taxes.

Investing in early child development has to take its place alongside widening access to high-quality higher education if we want people to have the maximum opportunity to flourish with a high degree of control over their lives and full participation in society.

Michael Marmot is professor of epidemiology and public health and director of the International Centre for Health and Society at University College London. His book Status Syndrome is published by Bloomsbury, £12.99.

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