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This report also seeks to determine the reverse relationship: that of academic performance onhealth. This relationship has been observed in the short-term. Studies in school aged children haveindicated that poor school performance predicts health-compromising behaviors and physical, mental andemotional problems (Crum et al., 1998; Kessler et al., 1995; Miller D. S. & Miller, 1997; Young & Rogers,1986). The long-term implications of academic performance on health status are not as clear, primarilybecause studies that assess health measures such as health literacy, mortality, infant mortality, morbidity,subjective health, risk factors and use of health care observe level of education as opposed to academicperformance. There is a body of evidence that suggests academic performance, particularly test scores,predicts level of attainment. An obvious example is the acceptance of measures such as the ScholasticAptitude Test (SAT) and Graduate Record Examination (GRE) as selective entrance requirements tocolleges and graduate programs respectively, and as such they serve as predictors of higher educationattainment. The studies that explore these relationships were not evaluated since they do not directlymeasure health outcomes, and they are found within a separate discipline. As stated, the relationshipbetween academic performance and future attainment is assumed, so for this report, the question subtlyshifts from how academic outcomes affect health to how education level affects health. However, focusshould not merely be on the linear relationship but also the intergenerational and cyclical nature betweeneducation and health. Parents and families profoundly influence their children. Those children develop asadults and form family units of their own. The interplay of health and education is perpetuated in thefamily cycle. Future generations will be influenced by what is done in the present. From this pointforward, the report will more fully focus on how education level affects health outcomes.The next part reports on research that closely examines the link between educational attainmentand adult health status. Here, the research has been more exploratory and has generated a range ofalternative explanations. We consider a wide sample of these. In sharp contrast to Part One, however,there is little attention given to interventions designed to take advantage of this link. While there is somediscussion of measures to attenuate the adverse effects of low educational attainment, say, throughliteracy campaigns, those in this field with an interest in educational interventions typically focus on earlychildhood as the most advantageous place to intervene.PART TWO: Educational Attainment and Adult Health StatusSection 1. Background on Social Status and Educational AttainmentMany studies have identified the importance of socioeconomic status (SES) in determiningindividual health. SES refers to the individual’s position or status in society’s hierarchy. Income,education, occupational status and social class are all indicators of SES and have been shown to beimportant determinants of health (Antonovsky, 1967; Backlund et al., 1996; Evans R. G. et al., 1994; KunstM. & Mackenbach, 1994; Marmot M. et al., 1987; Marmot M. & Shipley, 1996; Sorlie et al., 1995).Moreover, some studies report that disparities in all-cause mortality by socioeconomic class have beenincreasing rather than declining in recent years (Kunst A. et al., 1990; Pappas et al., 1993).The negative effect of poverty on health has been known for centuries with references going backto the ancient Greeks and Chinese (Krieger, 2001; Porter, 1997). Several historical records documentpoorer health among less advantaged populations. For example, Floud and Harris (1996) (Floud & Harris,1996) report that, at the beginning of the 19 th century, 14-year-old boys attending the Royal MilitaryAcademy at Sandhurst, the elite military school in Britain, were nearly six inches taller than theircounterparts in the Marine Society, who came from the lower social classes. Similarly, Rowentree in 1901documented an infant mortality gradient based on poverty in areas of York, England (Rowentree, 2001).In recent years, an abundant literature has documented a health gradient based on SES,particularly income. The evidence is overwhelming that SES and health are associated and that theassociation is represented by a gradient. Better-off individuals have better health than those who are lesswell-off, who in turn have better health than worse-off individuals. The gradient implies that the relationshipE-26