4 The Impact of Tertiary Educational Attainment on Inequalities in Self-Rated Health in Slovenia in 1989–2013 Period

Author(s):

Andrej Kirbiš(submitting)Marija Javornik Krečič(presenting)Marjeta Marković Darko Friš Marina Tavčar Krajnc

Conference:

ECER 2016

Network:

09. Assessment, Evaluation, Testing and Measurement

Format:

Poster

Session Information

09 SES 04.5 PS, General Poster Session

General Poster Session

Time:

2016-08-24

12:00-13:30

Room:

NM-Concourse Area

Chair:

Contribution

Previous studies on inequalities in health have consistently shown that people from lower socioeconomic groups have worse health-related outcomes; that socioeconomic inequalities in health can be found across developing and modernized countries; and that in recent decades health inequalities have not only continued but have also increased in many countries (Marmot et al., 1991; Macintyre, 1997; Adler and Ostrove, 1999; Lundberg and Lahelma, 2001; Ferrie et al., 2002; Phelan et al., 2010; Mackenbach, 2012). This also seems to be the case in Slovenia; a country which is ranked among socioeconomically more developed countries (e.g., it is ranked 25^th on Human Development Index (HDR, 2014)), yet it battles with substantial health inequalities. For example, a 30-year-old man with a university degree can expect to have a 7.3 years longer life than a man with completed primary education or less, while the infant mortality rate of babies whose mothers have (un)completed primary education is 2.6 times higher than those whose mothers have tertiary education (Buzeti et al., 2011).

Within literature on health inequalities, numerous previous studies have focused on the association between health and education, a key element of socioeconomic status (Ross and Wu, 1995; Chandola et al., 2006; Cutler and Lleras-Muney, 2006; Knesbeck et al., 2006; Golberstein et al., 2010), and found a positive impact of education on health even after adjusting for various other factors. For example, Golberstein and colleagues (2010) analysed the nature of the association between education and health, using a 23-year longitudinal secondary data and found considerable health-related returns to education even after controlling for confounding factors (i.e. family background) (also Winkleby et al., 1992; Grossman and Kaestner, 1997; Mirowsky and Ross, 2003; Kawachi et al., 2010). According to Grossman and Kaestner (1997), a causal effect of education on health exists that is due to greater efficiency of higher educated individuals in sustaining and fostering their health. Mirowsky and Ross (2003) have suggested that access of education to wider public, especially to those with lower social statuses, may be one of the best approaches to improve the overall health of the public and to mitigate health inequalities.

When examining the relationship between education and health, some more recent literature focused specifically on the effect of different educational levels, including tertiary education, on self-rated health. Ross and Wu’s (1995) analysis showed that individuals with tertiary education had reported significantly higher levels of self-rated health than those with a secondary level of education or less. The causal effect of education on health was found to be direct and strong even after adjusting for other possible factors that could explain the nature of this association (i.e. work and economic conditions, social-psychological resources, and health lifestyle).

Previous studies of Slovenian public have also found persistent and increasing inequalities in health (including subjective health) between educational groups, but these studies have several shortcomings. Specifically, previous analyses obscure the potential impact of tertiary educational attainment on health and the impact of the expansion of tertiary education (that took place in the last two decades) on health of Slovenian public.

The aims of our study was to go beyond previous research on health inequalities in Slovenia by focusing on the impact of tertiary education on self-rated health in longitudinal perspective. Specifically, our main research questions were: 1) have the differences in self-rated health between tertiary educational group and other educational groups from 1989 to 2013 increased/decreased or stayed relatively stable; 2) was tertiary education in the observed period the strongest predictor of self-rated health, among other socioeconomic and sociodemographic predictors; 3) has the impact of tertiary education on self-rated health changed in the observed period, controlling for other sociodemographic predictors.

Method

We employed representative national samples of Slovenian adults (Slovenian Public Opinion) from 1989 to 2013. Self-rated health as subjective health indicator was analysed. A large number of previous empirical studies have demonstrated that the indicator of self-rated health is a consistently strong predictor of future morbidity, mortality, functional (dis)ability and other indicators of health and quality of life, even when controlling for objective health status and other physical, sociodemographic and psychosocial health indicators (Kaplan and Camacho, 1983; Idler and Angel, 1990; Idler and Kasl, 1995; Idler et al., 2000; Idler and Benyamini, 1997; DeSalvo et al., 2006). Sociodemographic predictors We examined the impact of three sociodemographic predictors on self-rated health. First, age was measured as the year of birth and subsequently recoded into age in years. Second, gender (male = 1, female = 2) was measured with a standard self-report item. Third, size of residential settlement was measured on a scale from 1 (house in the countryside) to 5 (larger city). Socioeconomic predictors Income was measured as the quantity of personal income. Respondents stated their monthly income and we then sorted respondents into quartiles from the lowest do highest income group. Education was the final predictor and of most interest to us. In descriptive results we present outcome values for four educational groups (primary, secondary, vocational and tertiary educational group), while in regression analyses we dichotomized these values by combining non-tertiary education in order to specifically examine the impact of tertiary educational level and the impact of expansion of tertiary education on self-rated health.

Expected Outcomes

Analyses pointed to several important findings: 1) they confirm the existence of educational gradient in health with each higher educational group reporting better self-rated health than each previous educational group – at all four examined points of time; 2) there was an increase of mean values of self-rated health in all four groups when comparing the last year (2013) and the first year (1989); 3) tertiary educational group was the only group where mean self-rated health values increased at each subsequent time point, compared to the previous; 4) having already started from the highest mean value of self-rated health in 1989, the tertiary educational group’s self-rated health increased the most (10 %) in the observed period (1989–2013), followed by secondary educational group (4 %), primary educational group (3 %) and vocational group (1 %). Also, comparing the time point before global economic crisis (2003) and during it (2013), we found that self-rated health increased only in tertiary educational group, while it decreased in all three other groups. We controlled for all other variables included in the regression model and found age to be the strongest predictor of self-rated health at all four time points. Having a tertiary education was, next to age, the only determinant significant in all four years. Most importantly, the size of educational impact on self-rated health has increased, nearly doubled throughout the years (betas increased from .06 to .10), even after controlling for other variables. In other words, the health returns to tertiary education increased in Slovenia in 1989–2013 period, when enrolment in tertiary education has increased drastically (Tavčar Krajnc et al., 2014). In the last part of our paper, we discuss potential mechanisms through which tertiary education impacts self-rated health, and possible reasons for its increasing impact in last two decades are discussed.

References

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