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EXPLORING THE SOCIAL DETERMINANTS OF HEALTH
This issue brief, published in April 2011, is one in a series of 12 issue briefs on the social determinants of health. The series began as a product
of the Robert Wood Johnson Foundation Commission to Build a Healthier America.
ISSUE
BRIEF
# 5
Education and Health
1. Introduction
Everyone knows that without a good education, prospects for a good job with good
earnings are slim. Few people think of education as a crucial path to health, however.
Yet a large body of evidence strongly—and, with very rare exceptions, consistently—
links education with health, even when other factors like income are taken into
account. 1-6
By “education” we mean educational attainment, or the years or level of
overall schooling a person has, rather than instruction on specific health topics like
hygiene, diet or exercise; while the quality of education also is important for health
outcomes, this information is more difficult to measure and thus typically unavailable.
People with more education are likely to live longer, to experience better health
outcomes (Figures 1 & 2), and to practice health-promoting behaviors such as
exercising regularly, refraining from smoking, and obtaining timely health care check-
ups and screenings. 4, 7-9
Educational attainment among adults is linked with children’s
health as well, beginning early in life: babies of more-educated mothers are less likely
to die before their first birthdays, and children of more-educated parents experience
better health (Figures 3 & 4).
Education can influence health in many ways. This issue brief examines three major
interrelated pathways through which educational attainment is linked with health:
health knowledge and behaviors; employment and income; and social and
psychological factors, including sense of control, social standing and social networks.
In addition, this brief explores how educational attainment affects health across
A large body of
evidence links
education with health,
even when other factors
like income are taken
into account.
page 2
generations, examining the links between parents’ education—and the social and
economic advantages it represents—and their children’s health and social advantages,
including opportunities for educational attainment.
47.9
50.6
56.4
52.2
57.4
53.4
58.5
54.7
40
45
50
55
60
M E N WOM E N
Figure 1. For both men and women, more education typically means longer life.†
College graduates can expect to live at least 5 years longer than individuals who have not
finished high school.
Source: National Longitudinal Mortality Study, 1988-1998.
† This chart describes the number of years that adults in different education groups can expect to live
beyond age 25. For example, a 25-year-old man with only a high-school diploma can expect to live 50.6
more years and reach an age of 75.6 years.
L IF
E E
X P
E C
T A
N C
Y A
T A
G E
2 5
MEN WOMEN
Less than high-school graduate
High-school graduate
Some college
College graduate
Educational Attainment
Less than high-school graduate
High-school graduate
Some college
College graduate
Educational Attainment
72.7
84.1
70.4 70.6 69.4
62.2 67.2
59.4 60.9
50.0 54.7 54.1
48.6
57.5
41.443.6 41.0 39.5
41.8
26.7
0
20
40
60
80
100
Black, Non-Hispanic Hispanic Asian American Indian or Alaska
Native
Other‡
P E
R C
E N
T O
F A
D U
L T
S , A
G E
S 2
5 -7
4 Y
E A
R S
,
IN L
E S
S T
H A
N V
E R
Y G
O O
D H
E A
L T
H *
Figure 2. Less education is linked with worse health.†
Across racial or ethnic groups, adults with greater educational attainment are less likely to
rate their health as less than very good.
Source: Behavioral Risk Factor Surveillance System Survey Data, 2005-2007.
† Based on self-report and measured as poor, fair, good, very good or excellent.
* Age-adjusted.
Less than high-school graduate
High-school graduate
Some college
College graduate
Educational Attainment
Less than high-school graduate
High-school graduate
Some college
College graduate
Educational Attainment
BLACK,
NON-HISPANIC HISPANIC ASIAN AMERICAN INDIAN
OR ALASKA NATIVE
WHITE,
NON-HISPANIC
BLACK,
NON-HISPANIC HISPANIC ASIAN AMERICAN INDIAN
OR ALASKA NATIVE
WHITE,
NON-HISPANIC
People with more
education are likely
to live longer and
experience better
health outcomes.
Figure 1. For both men and
women, more education
typically means longer life. +
College graduates can expect
to live at least 5 years longer
than individuals who have not finished high school.
Figure 2. Less education is linked with worse health. +
Across racial or ethnic
groups, adults with greater educational attainment are
less likely to rate their health
as less than very good.
page 3
8.1
6.2
4.2
7.6
0
2
4
6
8
10
1
0-11 years
12 years
13-15 years
16 or more years
Mother’s Educational Attainment
0-11 years
12 years
13-15 years
16 or more years
Mother’s Educational Attainment
IN F
A N
T M
O R
T A
L IT
Y R
A T
E S
( P
E R
1 0
0 ,0
0 0 L
IV E
B IR
T H
S )
Source: Matthews TJ, MacDorman MF. Infant Mortality Statistics from the 2004 Period Linked Birth/Infant Death
Dataset. National Vital Statistics Reports, vol 55 no 15. Hyattsville, MD: National Center for Health Statistics, 2007.
Figure 3. Infant mortality rates vary by mother’s education. Babies born to mothers who have not finished high school are nearly twice as likely to die
before their first birthdays as babies born to college graduates.
Adults’ educational
attainment is linked
with their children’s
health, beginning early
in life.
Figure 3. Infant mortality
rates vary by mother’s
education. Babies born to
mothers who have not finished high school are
nearly twice as likely to die
before their first birthdays as babies born to college
graduates.
page 4
4.4
2.4
1.7
0.7
0
1
2
3
4
5
6
1
Figure 4. Parents’ education is linked with children’s health.†
Children whose parents have not finished high school are more than six times as likely
to be in poor or fair health as children of college graduates.
Source: National Health Interview Survey, 2001-2005.
† Based on parental assessment and measured as poor, fair, good, very good or excellent.
* Age-adjusted.
P E
R C
E N
T O
F C
H IL
D R
E N
, A
G E
S ≤
1 7
Y E
A R
S ,
W IT
H P
O O
R /F
A IR
H E
A L
T H
*
Less than high-school graduate
High-school graduate
Some college
College graduate
Parent’s Educational Attainment
Less than high-school graduate
High-school graduate
Some college
College graduate
Parent’s Educational Attainment
Figure 4. Parents’ education
is linked with children’s
health. + Children whose parents have not finished high
school are more than six
times as likely to be in poor or fair health as children of
college gradutes.
page 5
LOW EDUCATIONAL ATTAINMENT IS A MAJOR PROBLEM IN THIS COUNTRY
In the United States overall, nearly 16 percent of adults ages 25 years and older have not completed high school, 30 percent have no
schooling beyond high school, 27 percent have attended but not completed college, and 28 percent are college graduates (Figure 5).
These overall percentages mask dramatic differences across racial or ethnic groups, however: for example, 50 percent of Asian and 31
percent of non-Hispanic white adults are college graduates, compared with 17 percent of non-Hispanic black and 13 percent of Hispanic
and American Indian or Alaska Native adults.
Approximately 30 percent of high-school freshmen in this country—and nearly half of all freshmen in school systems in the 50 largest
U.S. cities—fail to graduate within four years.10 The likelihood of dropping out increases with decreasing income. In 2007, for example,
17 percent of 16- to 24-year-olds from families in the lowest income quartile were not enrolled in high school and had not received a
high-school credential, compared with 3 percent of those from families in the highest income quartile.11 At the same time, college has
become increasingly unaffordable for low- and middle-income families. For the 2007-2008 school year, net college costs for a family in
the lowest income quintile represented 55 percent of median family income, compared with 33 percent, 25 percent, 16 percent and 9
percent, respectively, for families in successively higher income quintiles.12 In response to budget constraints, at least 28 states cut
funding for public colleges and universities and/or substantially increased college tuitions in their 2009 fiscal year budgets.13
The United States is the only industrialized nation where young people currently are less likely than members of their parents’ generation
to be high-school graduates.14 Given the changing demography of the country and the escalating costs of college, bold action will be
needed to meet President Obama’s goal of having the highest proportion of college graduates in the world by 2020.
The United States is the
only industrialized
nation where young
people currently are
less likely than
members of their
parents’ generation to
be high-school
graduates.
page 6
2. How does education influence health?
Researchers have found supporting evidence for each of the following interrelated
pathways (Figure 6):
A. EDUCATION CAN LEAD TO IMPROVED HEALTH BY INCREASING HEALTH KNOWLEDGE AND HEALTHY BEHAVIORS
This is the pathway that many people think of first to explain the strong links between
education and health. Education can increase people’s knowledge, problem-solving,
and coping skills, enabling them to make better-informed choices among the health-
related options available for themselves and their families, including those related to
obtaining and managing medical care. 4, 15-20
Greater educational attainment has been
associated with health-promoting behaviors including increasing consumption of fruits
and vegetables and other aspects of healthy eating, engaging in regular physical activity
and refraining from smoking (Figure 7). 21-25
In addition, changes in health-related
behaviors in response to new evidence, health advice and public health campaigns
(about the risks of smoking, for example) tend to occur earlier among more-educated
people. 4, 26
As discussed in the section below on employment, more education is typically linked
with higher-paying jobs providing the necessary income to live in neighborhoods that
are less stressful, have stores with affordable healthy foods, and provide access to
recreational facilities. In other words, people with more education are more likely to
live in health-promoting environments that encourage and enable them to adopt and
maintain healthy behaviors.
HEALTH
Exposure to hazards
Control / demand imbalance
Stress
Housing
Neighborhood environment
Diet & exercise options
Stress
Working
conditions
Income
HEALTH
HEALTH
Figure 6. Education could affect health through many different pathways.
Work-related factors
Health-related behaviors
Coping & problem-solving
Response to stressors
Social networks
Social & economic resources
Perceived status
Stress
Social & economic resources
Social support
Norms for health-related behaviors
Stress
HEALTH
Control beliefs (sense / locus of control,
powerlessness, fatalism,
mastery, self-efficacy)
Educational
attainment
Educational
attainment
Educational
attainment
•Health knowledge
•Literacy
•Coping & problem-solving
Diet
Exercise
Smoking
Health & disease management
Work-related resources
Health insurance
Sick leave
Retirement benefits
Wellness programs
Stress
Work
Social standing
Education is linked
with health through
three major
interrelated pathways:
health knowledge and
behaviors, employment
and income, and social
and psychological
factors.
Figure 6. Education could
affect health through many
different pathways.
page 7
The links between education and health through health knowledge and behaviors are
likely to be explained at least in part by literacy. 27, 28
Low literacy is common in the
United States (a 2003 survey found that 30 million or 14 percent of U.S. adults had
literacy levels below the level needed to perform “simple and everyday” literacy
activities), with higher prevalence among people with fewer years of education. 29
More
specifically, average health literacy (i.e., the degree to which individuals have the
capacity to obtain, process and understand basic health information and services needed
to make appropriate health decisions and adhere to sometimes complex disease
management protocols) increases with educational attainment. The proportion of
American adults with “below basic” health literacy, for example, ranges from 3 percent
of college graduates to 15 percent of high-school graduates and 49 percent of adults
who have not completed high school. 29
Levels of health literacy in turn have been
associated with self-reported overall health, which correlates strongly with objective
clinical assessments: 30, 31
compared with adults who have adequate functional health
literacy, adults with inadequate functional health literacy are more likely to rate their
health as poor. 32
B. GREATER EDUCATIONAL ATTAINMENT LEADS TO BETTER EMPLOYMENT OPPORTUNITIES AND HIGHER INCOME, WHICH ARE LINKED WITH BETTER HEALTH.
Education provides the knowledge and skills necessary for employment, which can
shape health in many ways. More education generally means a greater likelihood of
being employed at all, and of having a job with healthier working conditions, better
employment-based benefits and higher wages (see the “Work and Health” issue brief in
this series).
• Education, unemployment, financial instability and health. Americans with lower
educational attainment are more likely to be affected by fluctuations in the
economy. While current unemployment rates are higher now than in more than a
quarter-century, increases in unemployment rates over the past year have been
greatest for adults who have not completed high school—6.9 percentage points,
compared with 2.2 percentage points for college graduates. 33
In June 2009,
0
10
20
30
40
50
19 74
19 75
19 76
19 77
19 78
19 79
19 80
19 81
19 82
19 83
19 84
19 85
19 86
19 87
19 88
19 89
19 90
19 91
19 92
19 93
19 94
19 95
19 96
19 97
19 98
19 99
20 00
20 01
20 02
20 03
20 04
20 05
P E
R C
E N
T O
F A
D U
L T
S , A
G E
S ≥
2 5 Y
E A
R S
, W
H O
A R
E C
U R
R E
N T
S M
O K
E R
S *
Figure 7. Persistent education gaps in smoking. Education disparities in cigarette smoking have persisted over decades. While rates of
smoking have declined in every education group, the gaps between college graduates and
those with less education appear to have widened.
Source: National Center on Health Statistics. Health, United States, 2006 with Chartbook on Trends in the
Health of Americans. Hyattsville, MD.
*Age-adjusted.
1976 1980 1984 1988 1992 1996 2000 20041976 1980 1984 1988 1992 1996 2000 2004
Less than high-school graduate
High-school graduate
Some college
College graduate
Educational Attainment
Less than high-school graduate
High-school graduate
Some college
College graduate
Educational Attainment
More education
generally means a
greater likelihood of
being employed at all,
and of having a job
with healthier working
conditions, better
employment-based
benefits and higher
wages.
Figure 7. Persistent
education gaps in smoking.
Education disparities in
cigarette smoking have persisted over decades.
While rates of smoking have
declined in every education group, the gaps between
college graduates and those
with less education appear to
have widened.
page 8
unemployment rates were 15.5 percent for adults who had not graduated from high
school, 9.8 percent for high-school graduates, 8.0 percent for those who had
attended but not completed college, and 4.7 percent for college graduates. 33
These
differences have major health implications; compared with their employed
counterparts, people who are unemployed experience poorer health and higher
mortality rates. 34-37
• Education, working conditions and health. Workers with less formal education and
training are more likely to hold lower-paying jobs with more occupational hazards,
including environmental and chemical exposures (e.g., pesticides, asbestos) and
poor working conditions (e.g., shift work with few breaks, potentially harmful tools)
that put them at higher risk of injury and fatality. 38
Less-educated workers are also
likely to experience more psychosocial stress at work 39-41
—for example, to have
jobs that make high demands yet offer few opportunities for control and skill
utilization. Such psychosocial aspects of work—including perceived balance
between a worker’s efforts and rewards, perceived justice and discrimination in the
workplace, and social support among co-workers—have been shown to have both
short- and longer-term impacts on health, particularly through pathways related to
stress.
• Education, work-related benefits and health. Less-educated workers in lower-wage
jobs also are less likely to have health-related benefits including paid sick and
personal leave, workplace wellness programs, child and elder care resources, and
retirement benefits, in addition to employer-sponsored health insurance. Although
most Americans receive their health insurance through their jobs, not all workers
have access to this benefit. Employers with lower-wage workers offer health
insurance less frequently, and, even if employment-sponsored benefits are available,
low-wage workers may be unable to afford the premiums, copayments or
deductibles. 42, 43
• Education, income and health. For the vast majority of Americans, employment is
the sole or main source of income―a work-related resource that affects health
through multiple well-documented direct and indirect pathways. 7 With limited
exceptions, greater educational attainment generally corresponds with higher-paying
employment. A recent study estimated that on average each additional year of
schooling represents an 11 percent increase in income; 44
median yearly earnings in
2007 were $32,862 for a full-time year-round worker with only a high-school
degree, $40,769 for a worker with some college, and $56,118 for a worker with a
bachelor’s degree. 45
These differences are particularly dramatic when compounded
over a person’s lifetime: lifetime earnings (in 1999 dollars, and based on a 40-year
full-time work life) for adults who have graduated from high school but not attended
college have been estimated at $1.2 million, compared with $2.1 million for those
with bachelor’s degrees and $4.4 million for those with post-baccalaureate
professional degrees. 46
Higher-paying jobs offer greater economic security and increased ability to accumulate
wealth, enabling individuals to obtain health care when needed, to provide themselves
and their families with more nutritious foods, and to live in safer and healthier homes
and neighborhoods with supermarkets, parks and places to exercise 47, 48
—all of which
can promote good health by making it easier to adopt and maintain healthy behaviors.
Work-related income may also affect health through pathways involving stress. Lower-
paid workers experience greater stress because they have fewer financial resources to
cope both with everyday challenges, including child care and other family
responsibilities, and with unexpected challenges such as illness. 7
More education can
lead to higher-paying
jobs, which enable
people to obtain health
care when needed,
provide themselves and
their families with more
nutritious foods, and
live in safer and
healthier homes and
neighborhoods with
supermarkets, parks
and places to
exercise—all of which
can promote good
health by making it
easier to adopt and
maintain healthy
behaviors.
page 9
C. EDUCATION IS LINKED WITH SOCIAL AND PSYCHOLOGICAL FACTORS THAT AFFECT HEALTH
Education is linked with social and psychological factors, including sense of control,
social standing and social support. These factors can improve health through reducing
stress, influencing health-related behaviors and providing practical and emotional
support.
• Control beliefs. Education may influence health by shaping people’s sense of
personal control—their perceptions of the extent to which they can influence their
life circumstances. Several studies have concluded that more education confers a
greater sense of personal control (or the related notions of mastery, self-efficacy and
internal locus of control), which perhaps is not surprising given the influence of
education on prospects for jobs and income. Higher levels of education have been
observed to foster skills, habits and attitudes—such as problem-solving,
purposefulness, self-directedness, perseverance and confidence—that contribute to
people’s expectations that their own actions and behaviors shape what happens to
them. Lower levels of education, on the other hand, may lead to experiences that
produce fatalism, a sense of powerlessness, or the belief that one’s own efforts are
less important than the influence of chance or powerful others when it comes to
health or life outcomes. 50-53
Positive beliefs about personal control have been
linked with health outcomes including higher levels of self-rated health, lower levels
of physical impairment and decreased risk of chronic conditions; they also has been
associated with health-related behaviors including smoking, alcohol consumption,
physical activity and diet. 50, 51, 53-55
Sense of control may also influence health
through job-related pathways, by affecting a person’s job seeking and performance,
for example. 56-58
It is important to note that an individual with a greater sense of
control may also be more likely to achieve higher educational attainment, making it
difficult to separate out the effects of sense of control and education on health.
• Social standing. Many experts believe that social standing is another important
factor linking education with health. Along with income and occupation,
educational attainment is an important determinant of where individuals rank within
social hierarchies that reflect status and influence in societies. Greater educational
attainment typically is associated with higher social standing, which in turn has been
linked with better health status. 59
An individual’s perception of where she or he
ranks in a social hierarchy has been referred to as subjective social status and has
been shown to powerfully predict health status even after controlling for
conventional measures of socioeconomic status such as occupation, income and
education. 60-62
While the pathways linking it to health are not well understood,
Social and
psychological factors
linked with education
can influence health
through pathways
related to stress,
health-related
behaviors, and
practical and emotional
support.
STRESS AND HEALTH
Much has been learned recently about physiologic pathways that help explain the links between education and health. Coping with the
constant challenges of daily living―balancing the demands of work and family, for example―can be particularly stressful for people
whose financial and social opportunities and resources have been limited by low educational attainment. Stressful experiences have
been linked repeatedly with many adverse health outcomes across the life course, through physiological mechanisms including
neuroendocrine, immune and vascular responses to stressors. Stress can trigger the body to release hormones and other substances that
over time can damage immune defenses and vital organs. The physiologic chain of events can accelerate aging and lead to serious
chronic illnesses including cardiovascular disease.49
page 10
subjective social status may be a more comprehensive reflection of social and
economic resources. 62
• Social networks. Education may also be linked to health through its influence on
social networks, which can be a source of both emotional support (having someone
to turn to for comfort or advice) or practical support (having someone to turn to for
practical or material help). Higher educational attainment, income and occupational
status all have been associated with higher levels of social support. 63-65
Higher
educational attainment increases a person’s likelihood of having close friends on
whom to rely and of experiencing greater family stability, including a stable and
supportive marriage. 3 Formal educational settings may encourage the development
of friendships and interpersonal skills; people with more education and related
social advantages may also have more time and resources to maintain relationships
and support friends emotionally and financially. 63, 66
Higher levels of social support have been linked with better physical and mental
health outcomes. 67-70
People with more social contacts have lower mortality rates
across multiple age groups and in both sexes, and disruptions in family stability
have been linked with worse health among adults and poorer health behaviors and
well-being among children. 3, 71-75
Social support can buffer the health-damaging
effects of stress by reducing negative emotional and behavioral responses to
stressful situations. 76, 77
Social relationships may also have beneficial health effects
unrelated to stress: 70, 78
larger social networks can provide access to employment,
housing and other opportunities and resources that influence health, 79-81
and
behavior norms within social groups can influence health-related behaviors such as
smoking, exercise and alcohol consumption. 69
3. Parents’ education influences children’s prospects for health during childhood and beyond
Parents’ educational attainment is linked to their children’s health and their children’s
educational attainment—both of which influence their children’s health as adults.
As illustrated in Figures 3 and 4, parents’ education is strongly linked to their children’s
health and development. 82-85
Parents with lower educational attainment typically face
greater obstacles—including lack of knowledge, skills, time, money and other
resources—to creating healthy home environments and modeling healthy behaviors for
their children. The quality of children’s health and development in turn influences
health later in life, through both direct and indirect pathways. A large body of research
has consistently linked adverse effects on brain, cognitive and behavioral development
early in life with important health outcomes later in life, including cardiovascular
disease and stroke, hypertension, diabetes, obesity, smoking, drug use and depression—
conditions that account for a major portion of preventable morbidity and premature
Parents’ educational
attainment is linked to
their children’s health
and their children’s
educational
attainment—both of
which influence their
children’s health as
adults.
Figure 8. The impact of
education on health crosses
generations.
page 11
mortality in the United States. Healthy development in childhood can also affect health
later in life through its association with greater academic achievement and educational
attainment 86
(see the “Early Childhood Experiences and Health” issue brief in this
series).
Parents’ educational attainment can also shape children’s prospects for healthy lives
through links to children’s educational attainment. Children’s academic achievement is
associated with parental education and related social and economic advantage; children
with less-educated parents and lower-income families face greater obstacles to success
in school and are less likely to go on to receive college educations (Figure 9). 44, 87-92
Parents’ education levels can affect their children’s education prospects both directly,
through the kinds of support and resources parents are able to provide at home, and
indirectly, through the quality of schools their children are likely to attend. Less-
educated parents are less likely to have high educational expectations and to create
stimulating and nurturing environments for their children; 93
in addition, they are more
likely to live in lower-income neighborhoods in which schools may have insufficient
resources. The level of educational attainment children eventually achieve affects their
health as adults, through the same pathways experienced by their parents, and it also
affects the health of their own children in turn—perpetuating a vicious intergenerational
cycle of low educational attainment and poorer health.
5.9
13.3
25.7
49.4
65.4
73.3
0
20
40
60
80
100
Figure 9. Children with less educated parents are less likely to succeed in school.
Source : Snyder TD, Dillow SA, Hoffman CM. Digest of Education Statistics, 2006. National Center for Education
Statistics, Institute of Education Sciences, US Department of Education. Washington, DC: US Government Printing
Office, 2007.
Less than high-school graduate
High-school graduate
Some college
Bachelor’s degree
Master’s degree
First-professional or doctor’s degree
Parent’s Educational Attainment
Less than high-school graduate
High-school graduate
Some college
Bachelor’s degree
Master’s degree
First-professional or doctor’s degree
Parent’s Educational Attainment
P E
R C
E N
T O
F 1
9 9 0 H
IG H
-S C
H O
O L S
O P
H M
O R
E S
W H
O
O B
T A
IN E
D A
B A
C H
E L O
R 'S
D E
G R
E E
O R
H IG
H E
R B
Y 2
0 0 0
The level of
educational attainment
children eventually
achieve also affects the
health of their own
children—perpetuating
a vicious
intergenerational cycle
of low educational
attainment and poorer
health.
Figure 9. Children with less
educated parents are less
likely to succeed in school.
page 12
4. Improving health through education policies and programs
By providing the knowledge and skills necessary to fully participate in the labor force,
education can be key in promoting social mobility and in breaking the cycle of
intergenerational disadvantage and related health disparities. 44, 92
Investments to
promote and increase educational attainment could have both human and economic
benefits; for example, a recent analysis estimated that, if adult Americans who have not
completed college experienced the lower death rates and better health of college
graduates, the resulting improvements in health status and life expectancy would
translate into potential gains estimated at more than $1 trillion annually. 7
Current knowledge described in this brief indicates that one of the most effective
strategies for reducing health disparities in this country could be to take steps to close
the gaps in educational attainment. Reviewing specific policies and programs to
increase educational attainment was beyond the scope of this brief, but more
information can be obtained from the resources listed below.
RESOURCES
• Achieve www.achieve.org
• Alliance for Excellent Education http://www.all4ed.org/
• The Annie E. Casey Foundation http://www.aecf.org/OurWork/Education.aspx
• Bill and Melinda Gates Foundation
United States Program http://www.gatesfoundation.org/united-
states/Pages/united-states-education-
strategy.aspx
• Brown Center on Education Policy at
Brookings http://www.brookings.edu/brown.aspx
• Center for Research on Education,
Diversity and Excellence http://crede.berkeley.edu/
• Education Commission of the States http://www.ecs.org/
• The Education Trust http://www2.edtrust.org/edtrust/default
• Future of Children www.futureofchildren.org
• Lumina Foundation http://www.luminafoundation.org/
• Mathematica Policy Research, Inc. http://www.mathematica-mpr.com/education/
• National Assessment of Educational
Progress http://www.nces.ed.gov/nationsreportcard/
• National Center for Education Statistics http://www.nces.ed.gov/
• National Center for Post-Secondary
Improvement http://www.stanford.edu/group/ncpi/
• The National Center for Public Policy
and Higher Education http://www.highereducation.org/index.shtml
• Promising Practices Network http://www.promisingpractices.net/
• RAND Education http://www.rand.org/education/
• U.S. Department of Education http://www.ed.gov/index.jhtml
By providing the
knowledge and skills
necessary to fully
participate in the labor
force, education can be
key in promoting social
mobility and in
breaking the cycle of
intergenerational
disadvantage and
related health
disparities.
page 13
ABOUT THE ROBERT WOOD JOHNSON FOUNDATION
The Robert Wood Johnson Foundation focuses on the pressing health and health care
issues facing our country. As the nation's largest philanthropy devoted exclusively to
improving the health and health care of all Americans, the Foundation works with a
diverse group of organizations and individuals to identify solutions and achieve
comprehensive, meaningful and timely change. For 40 years, the Foundation has
brought experience, commitment, and a rigorous, balanced approach to the problems
that affect the health and health care of those it serves. When it comes to helping
Americans lead healthier lives and get the care they need, the Foundation expects to
make a difference in your lifetime.
ABOUT THE COMMISSION TO BUILD A HEALTHIER AMERICA
The Robert Wood Johnson Foundation Commission to Build a Healthier America was a
national, independent, non-partisan group of leaders that released 10 recommendations
to dramatically improve the health for all Americans. www.commissiononhealth.org
ABOUT THIS ISSUE BRIEF SERIES
This issue brief is one in a series of twelve on the social determinants of health. The
series began as a product of the Robert Wood Johnson Foundation Commission to
Build a Healthier America.
CREDITS: LEAD AUTHORS
University of California, San Francisco
Center on Disparities in Health
Susan Egerter, Ph.D.
Paula Braveman, M.D., M.P.H.
Tabashir Sadegh-Nobari, M.P.H.
Rebecca Grossman-Kahn
Mercedes Dekker, M.P.H.
PHOTOGRAPHY
Elisabeth Fall, pg. 1
Robert Wood Johnson Foundation, pg. 12
page 14
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