Family Centred Primary Health Care Report

A Summary of the Evidence - The relationship between health and education

Review of evidence and models funded by the Office for Aboriginal and Torres Strait Islander Health Department of Health and Ageing, Canberra

Page last updated: 13 October 2011

There is strong evidence linking early childhood development to literacy, social competence and success in school, and in turn, that education attainment is linked to personal health status and socio-economic position later in life.

Put at its simplest, those with poor social and health environments at the beginning of their lives are likely to have poor education outcomes, and then poorer health outcomes later in their lives, whether measured by health knowledge, intermediate disease markers, measures of morbidity, general health status, and use of health resources.85 Similarly, improved education can independently override these effects.

Writing in this field began in the 1970s with work on the social determinants of health and developing country transitions demonstrating the impact of socio-economic disadvantage at a community and neighbourhood level in terms of poorer health outcomes86. Educational attainment consistently ranked as a key indicator and mediator of such disadvantage. Since then, an extensive literature has developed that demonstrates the links between child development, education and health along the life course: at an individual level, at the level of the family, and of the community.

Children who can read and write and numerically calculate are most likely to be long-lived, healthy, and have a positive place in society.87 On the other hand, children that are brought up experiencing disadvantaged, neglectful or abusive early childhood development conditions may show antisocial behaviour by the time they enter the school system, and have reduced performance throughout their school years88. Further literature indicates an association between IQ in childhood, and health later in life.89

There are a number of interconnected pathways by which this effect may be expressed.

First is the importance of work and class, or socioeconomic status. Education is the key to one’s place in a stratified economy90 where educated children are more likely to grow up into adults with better socioeconomic status which is strongly associated with better health, a greater ability effectively to access health services and lower mortality.91

Second, education is associated with better social-psychological resources: stressors, hardships, beliefs and behaviours are not randomly distributed but are socially structured. The sense of control over one’s own life increases with education, employment and income.92 Some Australian literature points to pathways between educational attainment and impact on the social and emotional well-being of Indigenous peoples.93

Third are some of the practical skills that come with better education, allowing individuals to be better able to manage their health (e.g. to access services, comprehend health messages, and advocate on their own behalf).94 Many ‘lifestyle factors’ such as eating well, drinking moderately, not smoking and preventive health care are strongly associated with better education.95 These ‘individual choice’ capacities are enabled by affluence and means, to which education once again contributes.

Fourth there is considerable international literature connecting the educational attainment of parents, in particular the mother, and child health outcomes. In developing countries a clear relationship is found between education of the mother and reduced infant child mortality, which is thought to be related to the greater autonomy and control of women over their lives and the lives of their children.96 In addition, poor maternal education in industrialised countries leads to increased risk of developmental delay for their children.97

85 Dewalt D A and Berkman N D (2004) ‘Literacy and health outcomes: a systematic review of the literature’ Journal of General Internal Medicine 19.
86 Caldwell J C (1986) ‘Routes to Low Mortality in Poor Countries’ Population and Development Review 12:171-220; Flegg A T (1982) ‘Inequality of Income, Illiteracy and Medical-Care as Determinants of Infant-Mortality in Underdeveloped-Countries’ Population Studies 36:441-458; Rogers R G and Wofford S (1989) ‘Life Expectancy in Less Developed-Countries – Socioeconomic Development or Public Health’ Journal of Biosocial Science 21:245-252.
87 Mustard 2006 op cit.
88 Tremblay R E (1999) ‘When children’s social development fails’ In Keating D & Hertzman C (Eds.) Developmental health and the wealth of nations: Social, biological, and educational dynamics (pp. 55-71). New York. Guilford.
89 Chandola T, Deary I J, Blane D and Batty G D (2006b) ‘Childhood IQ in relation to obesity and weight gain in adult life: the National Child Development (1958) Study’ International Journal of Obesity 30:1422-1432; Hart C L, Taylor M D, Smith G D, Whalley L J, Starr J M, Hole D J, Wilson V and Deary I J (2004) ‘Childhood IQ and cardiovascular disease in adulthood: prospective observational study linking the Scottish Mental Survey 1932 and the Midspan studies’ Social Science and Medicine 59:2131-8.
90Ross C E and Wu C (1995) ‘The Links Between Education and Health’ American Sociological Review 60 (5):719-745)
91 Hertzman and Wiens 1996 op cit.
92 Ross and Wu 1995 op cit; Marmot and Wilkinson 1998 op cit.
93 Corrigan M and Mellor S (2004) The Case for Change: A Review of Contemporary Research on Indigenous Education Outcomes. Australian Council on Educational Research; Hunter B H and Schwab R G (2003) Practical reconciliation and recent trends in Indigenous education. Centre for Aboriginal Economic Policy Research. Available:
94 Berkman N D, DeWalt D A, Pignone M P et al (2004) Literacy And Health Outcomes Evidence report/technology assessment Number 87 prepared for Agency for Healthcare Research and Quality (AHRQ) US Dept Health and Human Services)
95 Ross C E and Wu C L (1996) ‘Education, age, and the cumulative advantage in health’ J Health Soc Behav 37:104-20
96 Caldwell 1986 op cit; Caldwell 1990 op cit; Sandiford P, Cassel J, Montenegro M and Sanchez G (1995) ‘The Impact of Women's Literacy on Child Health and its Interaction with Access to Health Services’ Population Studies 49(1):5-17.
97 Shonkoff & Phillips 2000 op cit.