Education is a modifiable risk factor: let’s look to improving education to rid ourselves of health inequities

By Dr. Scott Lear

As thousands of students return to school this September to learn about the three Rs (reading, writing and arithmetic), we should add another R to the list: reducing disease and death.

When it comes to health, education matters. Not completing secondary education (such as a high school diploma) can increase your risk of early death by 50%. This is comparable to the risk of smoking and hypertension, and greater than the risk of being physically inactive.

In the United States, 11% of adults do not have a high school education. If all Americans completed high school, approximately 78,000 premature deaths per year could be prevented. The risk of death of a low education are even greater in middle and low income countries.

The benefits of education

There are a number of reasons why a higher education is associated with improved health. Low education is associated with risk factors such as such as obesity, hypertension and smoking, which all increase the risk of early disease and death.

Education brings with it knowledge and skills to problem solve. It allows for a higher capacity to process information, which results in higher health literacy and a greater understanding of what is and what isn’t healthy. People can make informed decisions around prevention and navigate the healthcare system. Indeed, cancer screening rates, dental checks and preventive care appointments in later life are higher in people with more education.

In addition, higher education is associated with employment in jobs with minimal health hazards, better safety procedures, wellness programs and the inclusion of extended health benefits. There is also a trickle-down effect to children with better child health and higher vaccination rates.

This makes education a foundational element of health and a public health concern. In effect, education is a modifiable risk factor no different from high cholesterol or high blood sugar.

Increasing education attainment

The effort needed isn’t that high, as the most striking gap in health is between completing and not completing high school. Students drop-out for a variety of reasons from acute situations such as hospitalization, pregnancy and changing schools, to more chronic occurrences such as learning disabilities, family and financial challenges. Drop-outs tend to be less in schools in which students feel engaged and part of the community.

While school counsellors may seem an obvious choice to turn to, students at risk for dropping out often do not feel comfortable seeking guidance from school staff. For these students, depending on their location, they may be referred to a patchwork of solutions in the community, or be left entirely on their own. As a result, the ability of the school system to solely address prevention of dropping out is limited and a party independent of the school system is needed.

The engagement of public health nurses presents an ideal opportunity. Nurses have extensive training in counselling and preventive health care. Public health nurses are already linked with local school systems, however, the focus of these positions is limited to traditional health issues such as immunization and sexual education. To be of benefit, we need to expand the role of public health nurses in schools.

This can include increasing the time and profile of nurses at the school to allow for student counselling, working with the schools’ counsellors in identifying and intervening with high-risk students and being a conduit for students to the health care social services systems. Any additional costs will be more than offset by the savings in downstream health care and other societal benefits of an educated population.

The stakes of doing nothing are high. Those with the lowest levels of education use a disproportionately high amount of healthcare services. Poor health can lead to an inability to work and provide for family members, which in turn can translate into a multi-generational issue as children of low educated parents tend to attain low levels of education themselves. Putting education firmly on the health agenda is essential for recognizing the value education has to health and prevent unnecessary disease, disability and death.


Dr. Scott Lear is a Professor in Health Sciences at Simon Fraser University and holds the Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention Research at St. Paul’s Hospital. He is living with heart disease and writes the blog Feeling Healthy with Dr. Scott Lear from his experience as both a researcher and patient.


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