Education programs are likely to improve health, but will they improve health equity?

Education is a strong predictor of health and longevity: the higher a person’s level of education, the greater the likelihood of a long and healthy life. This is true in the U.S. as well as in other parts of the world. The association is stronger in some countries than in others— for example, in the U.S. than in most Western European countries, perhaps because of greater economic returns to schooling in the U.S.—but it is otherwise remarkably consistent across time and place. This consistency has tempted researchers and policymakers alike to interpret the association as being causal— with the arrow of causality running from education to health, not the other way around. This is, however, not the only possible interpretation because good health and personal characteristics leading to better health, such as cognitive ability and time preference, may also lead to better educational outcomes. As true experiments are impossible, quasi-experimental studies are the best way to assess whether the effects of education on health and longevity are indeed causal. “Natural experiments” exploiting the introduction of compulsory schooling laws indeed generally show that an extra year of education leads to lower mortality in later life and thus support the claim that at least part of the commonly observed association between education and health is causal. This effect of education on health is probably due to the fact that education confers several health-related benefits, such as a better understanding of health risks, more effective utilization of health services, a more secure and fulfilling job, and a higher income. It is therefore also likely—although difficult to prove because of the long delays involved—that programs and policies that improve educational outcomes among young people at risk of not achieving their full educational potential have positive health effects. Educational policies, like housing and social security policies, are increasingly seen as an important adjunct to conventional health policies, and the inclusion by the U.S. Community Preventive Services Task Force of education programs and policies among the interventions for which it conducts effectiveness reviews is a welcome support to this development. As part of its focus on “health equity,” the U.S. Community Preventive Services Task Force has reviewed evidence on the effectiveness of several education programs: comprehensive programs for children of low-income families to foster early childhood