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Furthermore, health education campaigns are more effective in producing behavioral changes inbetter educated people. For example, smoking did not show a SES based gradient in the 1940s. Asinformation on the risks of smoking became widely available, the better educated quit at a higher rate thanthose with less education with the result that now smoking is concentrated among disadvantaged groups(Pierce et al., 1989). Similar patterns of change in the social distribution of risk factors have beenobserved for other diseases. Coronary heart disease (CHD) was a disease of the affluent with CHD riskfactors positively associated with SES in the 1950s, only to become more prevalent among the lesseducatedgroups as knowledge about risk factors increased (Morgenstern, 1980; Taylor, 1967). Morerecently, AIDS changed from being a disease of white middle-class homosexual to having a majority ofnew cases among minority groups with lower education (Peterson & Marin, 1988).Education and Health Care Costs. Low (2005) provides strong evidence that literacy predicts health carecosts. In the 1990s, Medicaid recipients at the lowest literacy levels had annual health care costs of$12,974 compared to $2,969 for the overall Medicare population and were twice as likely to have beenhospitalized in the previous year than patients with higher literacy (Weiss, 1999). Low literacy isresponsible for about $73 billion annually in avoidable health care costs according to an estimate by aNational Academy study on Aging Society.Section 3. How Educational Attainment Affects Adult Health StatusMirowsky and Ross (2003) consider several broad pathways through which education affectshealth. Education as learned effectiveness directly improves health, education increases the sense ofpersonal control, and education enhances material, social and psychological resources. FollowingMirowsky and Ross (2003), we will discuss these pathways in turn.The Human Capital View. Human capital is a concept derived from economics. In its original sense,human capital “concentrates on the agency of human beings – through skill and knowledge as well aseffort -- in augmenting production possibilities” (Sen, 1997, p 1959). Human capital can thus be employedas capital in production in the way physical capital is. The human capital perspective has been broadenedto cover not only economic production but to include production of other things that are valued, such ashealth and well-being.The human capital approach to education and health implies that education improves individual’sability to produce health. This is the approach that characterizes Mirowsky and Ross’ theory of educationas learned effectiveness (Mirowsky & Ross, 2003). Mirowsky and Ross (2003) argue that “educationenables people to coalesce health producing behaviors into a coherent lifestyle and that a sense of controlover outcomes in one’s own life encourages a healthy lifestyle and conveys much of education’s effect”(Mirowsky & Ross, 2003, p. 25). In this theory, education and income are distinct in their effects on health.Education, defined by the accumulated knowledge learned in school, is an antecedent to income in that“education is the key to people’s position in the stratification system” (Mirowsky & Ross, 2003, p. 25).Those who are better educated are more likely to have better jobs and better paying jobs, which in turnimprove health. But the major effect of education on health is not through economic resources.Education is a root cause of health in that it gives individuals the capacity to control and shapetheir own life in a way that promotes good health. The skills, knowledge, and resources acquired in schoolbuild abilities (the human capital) that increase effective agency and can be used to foster health. Thus“education as learned effectiveness” (Mirowsky & Ross, 2003). The resources acquired through educationare inherent in the people themselves, not only external (like money). Education increases the motivation,and success at solving problems, reduces helplessness, and improves the efficiency in producing healthfrom the material, social and psychological resources available to the individual. It teaches the ability tolearn, to be persistent, to communicate effectively, and to find and use information. So, for example, welleducatedpeople with lower income are better able to mange their reduced monetary resources to fend offE-30