09 SES 04.5 PS, General Poster Session
General Poster Session
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 25th 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.
Adler, N.E. and Ostrove, J.M. (1999). Socioeconomic Status and Health: What We Know and What We Don’t. Annals of the New York Academy of Sciences, 896: 3–15. Arendt, J. N. (2001). Education effects on Health: Causal of from Unobserved Components? A Panel Data Analysis with Endogenous Education. Copenhagen: Institute of Economics, University of Copenhagen. Chandola, T., Clarke, P., Morris, J. N. and Blane, D. (2006). Pathways between Education and Health: A Casual Modelling Approach. Journal of the Royal Statistical Society. Series A (Statistics in Society), 169(2), 337–359. Cutler, D. M. and Lleras-Muney, A. (2006). Education and Health: Evaluating Theories and Evidence. NBER Working Paper No. 12352. Kawachi, I., Adler, N. E. and Dow, W. H. (2010). Money, schooling, and health: Mechanisms and causal evidence. Annals of the New York Academy of Sciences, 1186, 56–68. Knesebeck, O., Verde, P. E. and Dragano, N. (2006). Education and health in 22 European countries. Social Science & Medicine, 63, 1344–1351. Lantz, P. M., House, J. S., Lepkowski, J. M., Williams, D. R., Mero, R. P. and Chen, J. (1998). Socioeconomic Factors, Health Behaviors, and Mortality: Results From a Nationally Representative Prospective Study of US Adults. American Medical Association, 279(21), 1703–1708. Marmot, M.G., Smith, G.D., Stansfeld, S., Patel, C., North, F., Head, J., White, I., Brunner, E., Feeney, A. (1991). Lancet, 337 (8754): 1387–1393. Macintyre, S. (1997). The black report and beyond what are the issues? Social Science & Medicine 44 (6): 723–745. Mackenbach J.P., Simon, J.G., Looman, C.W.N., Joung, I.M.A. (2002). Self-assessed health and mortality: Could psychosocial factors explain the association? International Journal Of Epidemiology, 31: 1162–1168. Ross, C. E. and Wu, C. (1995). The links between Education and Health. American Sociological Review, 60(5), 719–745. Silles, M. A. (2009). The causal effect of education on health: Evidence from the United Kingdom. Economics of Education Review, 28(1), 122–128. Yen, I. H. and Kaplan, G. A. (1999). Poverty area residence and changes in depression and perceived health status: evidence from Alameda Country Study. International Journal of Epidemiology, 28(1), 90–94. Wen, M., Broening, C. R. and Cagney, K. A. (2003). Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health. Social Science & Medicine, 57, 843–860. Winkleby, M. A., Jatulis, D. E., Frank, E. and Fortmann, S. P. (1992). Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. American Journal of Public Health, 82(6), 816–820.
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