COD E R E D

In the study of education and health, education is usually measured by years of completed formaleducation or by the highest degree obtained. For example high school graduates are compared to thosewithout a high school diploma or to those with a college degree. The impact on health outcomes of collegeselectivity for those with a college degree and the credential of a college degree have also beeninvestigated (Ross C. E. & Mirowsky, 1999).Section 2. The Links between Educational Attainment and Adult Health StatusThis section reviews the evidence that education improves health outcomes. We rely heavily onLow’s (Low, 2005) and Mirowsky and Ross (2003) (Mirowsky & Ross, 2003) excellent summaries inpresenting this evidence. In general, better educated people are healthier, report better health, and havelower mortality, morbidity and disability (Coburn & Pope, 1974; Ross C. E. & Van Willigen, 1997). Rossand Mirowsky (Ross C. E. & Mirowsky, 1999) have shown that the quality of the education received and ofthe educational environment increase the positive effects of education on health. The evidence that moreeducation is associated with better health is strong (Deaton & Paxton, 1999; Grossman & Kaestner, 1997;Kaplan & Kiel, 1993).Health Literacy and Health Knowledge. While education improves health, lack of education, and theresulting low literacy, is associated with poor health. Literacy, one of the main products of education, isassociated with several aspects of health. Health literacy allows individuals to understand and act uponhealth information and has been related to knowledge about health, personal health status, and the use ofhealth service. Literacy improves health knowledge and skills in managing their disease in patients withhypertension, diabetes, and asthma (Williams M. V. et al., 1998a; Williams M. V. et al., 1998b). Literacywas a better predictor of metastases than age and race in prostate cancer patients (Bennett C. L. et al.,1998).Mortality. A strong inverse relationship between years of education and all-cause mortality is reported byElo and Preston (Elo & Preston, 1996). Actuarial estimates show 5 to 6 years differences in lifeexpectancy between the least and the most educated (Rogot et al., 1992). Mortality rates vary greatly withyears of education, for example compared with individuals with 17 or more years of education, those with16 years are 25% more likely to die and those with less than 9 years of education are 100% more likely todie (Rogers et al., 1999). These differences in mortality rates by educational level have been increasingover time (Elo & Preston, 1996; Feldman et al., 1989).Infant Mortality. Infant mortality is a key indicator of health and wellbeing of societies (UNICEF, 2003).One of the best predictors and contributors to fetal and infant mortality is thought to be low birth weigh(Chen et al., 1998; Newland, 1981; Shapiro et al., 1980; Shoham-Yakubovich & Barell, 1988). Researchhas shown that mother’s educational level is inversely related to both infant mortality (Arntzen & NyboAndersen, 2004; Arntzen et al., 2004; Buor, 2003; Gisselmann, 2005; Olsen & Madsen, 1999; Pena et al.,2000) and low birth weight (Chen et al., 1998; Shapiro et al., 1980), that is, infant mortality risk decreasesas the mother’s educational level increases (Bicego & Boerma, 1993; Burne & Walker, 1991; Caldwel,1979; Newland, 1981; Wagstaff et al., 2004). Albeit the relationship might be well established, theexplanatory mechanisms behind this relationship are still debated. One of the possible pathways is thatmothers’ education increases the access and proper utilization of preventive or curative health carefacilities (Buor, 2003; Gubhaju, 1991), the personal skills and abilities and, more importantly, educationmay change traditional familiar relationships (Caldwel, 1979).Morbidity and Chronic Disease. There is evidence of a morbidity gradient based on education. Mirowskyand Ross (2003) report that less educated persons are more likely to suffer from the common chronicconditions, with the exception of cancer. For example, arthritis and osteoporosis, hypertension, heartdisease, diabetes and lung disease are more likely to be diagnosed among those with no high schooldegree and least likely in those with college degrees. The probability of reporting diagnosis of at least oneof the above condition is 35.7% for those with college degrees, 41.6% for those who completed highschool, and 64.7% for those who did not complete high school (Mirowsky & Ross, 2003).E-28