Indicator A6. How are social outcomes related to education?

Life expectancy reflects a long trajectory of individuals’ socio-economic circumstances that affect their health conditions and other mortality risks. In OECD countries, life expectancy at birth, on average, reached almost 81 years in 2018 and is about 5 years higher for women than for men (83 years for women, compared to 78 years for men) (OECD, Health Statistics database).

Life expectancy in OECD countries varies by socio-economic status as measured, for instance, by education level. A higher level of education not only provides the means to improve the socio-economic conditions in which people live and work, but may also promote the adoption of healthier lifestyles and facilitate access to appropriate health care (OECD, 2019[6]). On average across the 21 OECD countries with available data, at age 30, people with tertiary attainment can expect to live around 5 years longer than those with below upper secondary attainment (54 years versus 49 years) (Figure A6.1).

Data show that the association between education and life expectancy at age 30 is larger for men than for women. The average gap in life expectancy by level of education is six years for men, compared to three years for women. Differences are particularly wide in Hungary, Poland and the Slovak Republic, where a 30-year-old tertiary-graduated man can expect to live at least 11 years longer than a 30-year-old man who has not completed upper secondary education (Figure A6.1).

Adults with higher levels of education not only expect to live longer, but also report being in better health than adults with lower levels of education. Across OECD countries with available data, the higher the educational attainment, the higher the percentage of adults reporting being in good or very good health. In 2019, the share of those reporting being in good or very good health ranged from 37% (Lithuania) to 80% (Greece) among 25-64 year-old adults with below upper secondary attainment, from 45% (Lithuania) to 90% (Greece) among those with upper secondary or post-secondary non-tertiary education, and from 68% (Latvia) to 94% (Greece) among those with tertiary attainment (Table A6.2).

The difference in the percentage of adults with tertiary attainment reporting being in good or very good health versus those with below upper secondary attainment is larger for women than for men in all countries with available data. On average across the OECD countries participating in the EU-SILC, the gap in self-reported health (i.e. being in good or very good health) between 25-64 year-olds with tertiary attainment and those with below upper secondary attainment is 31 percentage points for women, compared to 24 percentage points for men. The gap in self-reported health ranges from 15 to 44 percentage points for women (Italy and the Czech Republic, respectively) and from 10 to 37 percentage points for men (Sweden and Poland, respectively). Overall, with the exception of Australia, this pattern is confirmed also across OECD countries with available data from national data sources or from the Survey of Adult Skills (PIAAC) (Figure A6.2).

An epidemic of obesity has been developing in virtually all OECD countries over the last 30 years. In 2015, nearly one in five adults (19.5%) were obese across the OECD (OECD, 2017[7]). Being overweight, including pre-obesity and obesity, is a major risk factor for chronic diseases such as diabetes, cardiovascular diseases and certain cancers (OECD, 2019[6]). The World Health Organization estimates that obesity causes at least 2.8 million deaths worldwide each year (WHO, 2021[8]). And there is some evidence that obesity increases the risk of becoming severely ill from COVID-19. For example, a study conducted in France concludes that the odds of developing a severe case of COVID-19 are seven times higher in patients with obesity (Simonnet et al., 2020[9]).

Many OECD countries are concerned not only about the pace of the increase in obesity, but also about inequalities in its distribution across social groups, particularly by level of education, socio-economic status and ethnic background (Devaux et al., 2011[10]).

Data confirm that adults with below upper secondary attainment have higher obesity prevalence than those with tertiary attainment. On average across the 26 OECD countries with available data, the incidence of obesity is particularly high among 25-64 year-olds with below upper secondary attainment (25%) and relatively low among those with tertiary attainment (14%) (Table A6.3).

The incremental difference in health outcomes associated with more education is commonly called the education gradient. The steeper the gradient, the stronger the association between educational attainment and health outcome. The gradient is greater than 10 percentage points in the majority of OECD countries with available data and is at least 14 percentage points in the Czech Republic and Slovenia and about 19 percentage points in Australia. In Latvia and the United States, 25-64 year-old the prevalence of obesity among adults with upper secondary or post-secondary non-tertiary attainment is higher than among those adults with below upper secondary or with tertiary attainment. In addition, these two countries are characterised by a relatively small (less than 5 percentage points) gradient (Figure A6.3).

The difference in the proportion of adults with obesity by educational attainment is slightly higher among women than among men. On average across OECD countries with available data, the education gradient is 13 percentage points for women, compared to 8 percentage points for men. This gradient is 15 percentage points or higher in 10 of the 26 OECD countries with available data for women, while for men this is true only in the case of Australia (Table A6.3).

While multiple factors contribute to weight gain, including genetic predisposition and environmental influences, overweight primarily occurs due to the imbalance between energy intake from diet and energy output through physical activity. Individuals living in OECD countries have increasingly unhealthy lifestyles, including a poor diet and an insufficient consumption of fruits and vegetables, a greater consumption of which has been associated with a reduced risk of obesity and other chronic diseases. In addition, people have self-reported insufficient levels of physical activity and spend a significant part of their time in sedentary behaviour involving very low energy expenditure (OECD, 2019[5]).

Individuals with a lower level of education or a lower socio-economic status are more likely to consume an unhealthy diet. On this, the WHO suggests consuming more than 400 greams of fruits and vegetables per day (i.e. five portions) to improve overall health and reduce the risck of becoming oveweight/obese or developing cardiovascular deseases, diabetes, cacers and respiratory deseases, among the others (WHO, 2020[11]).

On average across the 32 OECD countries with available data, the share of 25-64 year-olds consuming at least five portions of fruits and vegetables per day spans from 12% among those with below upper secondary attainment to 19% among those with tertiary attainment (i.e. an average gradient of 7 percentage points). This education gradient is 15 percentage points or higher in Denmark, Ireland and the United Kingdom; it is 5 percentage points or less in about half of the OECD countries with available data (Figure A6.4).

Men in general report consuming less fruits and vegetables than women do. In the large majority of OECD countries with available data, the share of men reporting eating at least five portions of fruits and vegetables per day is consistently lower than the share of women, regardless of level of education. In addition, the difference in the proportion of adults eating at least five portions of fruits and vegetables per day by educational attainment is relatively larger among women than among men. On average across OECD countries, this education gradient is 9 percentage points for women, compared to 4 percentage points for men (Table A6.4).

Individuals with a lower level of education or a lower socio-economic status are less likely to do sufficient physical activity outside their work. In particular, the WHO recommends that 16-64 year-olds spend between 150 and 300 minutes per week doing aerobic pysical activity (WHO, 2020[12]).

On average across the 30 OECD countries with available data, the share of 25-64 year-olds doing at least 180 minutes of non-work related physical activity per week ranges from 40% among those with below upper secondary attainment to 56% among those with tertiary attainment (i.e. an average gradient of 16 percentage points). This gradient is 30 percentage points or more in the Czech Republic and Lithuania; it is less than 10 percentage points in Estonia, Finland, Italy, the Netherlands, New Zealand and Norway (Figure A6.5).

On average across countries with available data, the difference in the percentage of adults with tertiary attainment reporting performing at least 180 minutes of non-work related physical activity per week versus those with below upper secondary attainment is larger for men than for women. The average gradient is 18 percentage points for men and 14 percentage points for women. It ranges between 8 (New Zealand) and 39 percentage points (the Czech Republic) for men and between 1 (the Netherlands), and 30 percentage points (Canada) for women (Table A6.5).

Age groups: Adults refer to 25-64 year-olds.

Educational attainment refers to the highest level of education successfully completed by an individual.

Education gradient refers to the difference in health outcomes between adults with tertiary attainment and those with a below upper secondary attainment.

Levels of education: See the Reader’s Guide at the beginning of this publication for a presentation of all ISCED 2011 levels.

Life expectancy at birth and at age 30 is the average number of years that a person at that age can expect to live, assuming that age-specific mortality levels remain constant over time.

Pre-obesity is defined as a body mass index from 25 to 29kg/m2, with weight in kilogrammes and height in metres.

Obesity is defined as a body mass index of 30kg/m2 or more, with weight in kilogrammes and height in metres.

The analyses presented in this indicator are based on the results of simple bivariate correlations. However, it is important to keep in mind that education does not act on health in isolation from other factors. In fact, there are many confounding factors influencing both education and behaviours, on the one hand, and health outcomes, on the other. In addition, the association between education and health is not unidirectional. Poor health may not only result from lower educational attainment, but it can also hinder access to higher levels of education. As such, the results discussed in this indicator should be interpreted with caution.

In addition, as most of the tables developed for this indicator combine data from different sources, in certain cases, cross-country comparability could be compromised. Thus, the main focus should be on within-county differences in health outcomes and behaviours across levels of educational attainment, rather than on cross-country comparisons.

For the European sources, the metadata information can be found in the following links: for the demographic statistics: https://ec.europa.eu/eurostat/cache/metadata/en/demo_mor_esms.htm; for the EU Survey on Income and Living Conditions (EU-SILC) and its ad hoc module “Health and Children’s health”: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=EU_statistics_on_income_and_living_conditions_(EU-SILC)_methodology; and for the European Health Interview Survey (EHIS): https://ec.europa.eu/eurostat/web/products-manuals-and-guidelines/-/KS-02-18-240.

For data from the Survey of Adult Skills (PIAAC), the observations based on a numerator with fewer than 5 observations or on a denominator with fewer than 30 observations times the number of categories have been replaced by “c” in the tables.

Data for the Box A6.1 used the following methodology by country:

  • Canada: The category “learning disability” also includes epilepsy, cerebral palsy, intellectual disability and learning disability. These other disabilities make up 14% of the total of the learning disability category. The comparison group consisted of students that had no long-term diagnosed health condition. Students were between 6 and 15 years of age when their long-term disability was diagnosed. Data are for 21-22 year-olds.

  • Israel: Learning disability category includes students in grade 11 or 12 that were identified and diagnosed with a learning disability and/or with ADHD. They were enrolled in the following three types of special settings: 1) students receiving inclusion services in regular classes; 2) special classes in regular schools; and 3) special schools (segregation). The comparison group consisted of the rest of the cohort, who have not been identified as special education needs students and were enrolled in a regular setting. Data are for 24 year-olds, to take into account the time required to complete compulsory service.

  • United States: Disability diagnosis is based on “parent told 9th grader has learning disability”. Comparison group includes students with parents that weren’t told that their 9th grader has a disability. Data are for 21-22 year-olds.

Post-secondary education for Israel refers to enrolment at the tertiary level only and excludes post-secondary non-tertiary, while post-secondary education for Canada and the United States includes all post-secondary enrolments.

  • For Table A6.1 (Life expectancy at age 30, by educational attainment and gender): Demographic statistics by Eurostat for European OECD member countries, except for Belgium, France, Iceland, the Netherlands and Spain; and national data sources (Belgium: Census 2011 and Population Register 2017; Canada: Canadian Census Health and Environment Cohorts; France: Échantillon démographique permanent; Iceland: Population Statistics; Israel: Israeli Social Survey; the Netherlands: National Health Statistics; and Spain: Indicadores Demográficos Básicos).

  • For Table A6.2 (Percentage of the population reporting being in good or very good health, by educational attainment and gender): EU Survey on Income and Living Conditions (EU-SILC) for European OECD member countries; the OECD Health Database for Chile, Japan and Korea; the OECD Survey of Adult Skills (PIAAC) for Mexico; and national data sources (Australia: National Health Survey; Canada: Canadian Community Health Survey; Israel: Israeli Social Survey; New Zealand: New Zealand Health Survey; and the United States: National Health Interview Survey).

  • For Table A6.3 (Proportion of obese adults, by educational attainment and gender): EU-SILC ad hoc module “Health and children’s health” for European OECD member countries except for Italy and Portugal; and national data sources (Australia: National Health Survey; Canada: Canadian Community Health Survey; Israel: Israeli Social Survey; Italy: data submitted to Eurostat [but not published yet] according to the 2019 European Health Interview Survey (EHIS); New Zealand: New Zealand Health Survey; Portugal: National Health Survey [follows the EHIS regulations]; Switzerland: Survey on Income and Living Conditions [SILC]; and the United States: National Health and Nutrition Examination Survey).

  • For Table A6.4 (Percentage of adults who report consuming at least five portions of fruits and vegetables per day, by educational attainment and gender): EHIS for European OECD member countries, except Portugal; and national data sources (Australia: National Health Survey; Canada: Canadian Community Health Survey; Israel: Israeli Social Survey; New Zealand: New Zealand Health Survey; Portugal: National Health Survey [follows the EHIS regulations]; Switzerland: Swiss Health Survey; and the United States: National Health and Nutrition Examination Survey).

  • For Table A6.5 (Percentage of adults who report performing at least 180 minutes of physical activity per week, by educational attainment and gender): EU-SILC ad hoc module “Health and children’s health” for European OECD member countries except Portugal; Australia: National Health Survey; Canada: Canadian Community Health Survey; Israel: Israeli Social Survey; New Zealand: New Zealand Health Survey; Portugal: National Health Survey [follows the EHIS regulations]; Switzerland: Survey on Income and Living Conditions [SILC]; and the United States: National Health and Nutrition Examination Survey).

  • Data for Box A6.1 used national sources (Canada: National Longitudinal Survey of Children and Youth [2000-01 cohort aged 0-11] and T1 Family File [T1FF 2004 to 2015] linked data); Israel: Israel Ministry of Education Administrative Data Files, 1993 birth cohort; and the United States: High School Longitudinal Study of 2009 (HSLS:09) Second Follow-Up (2016)).

References

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[8] WHO (2021), “Obesity”, web page, World Health Organization, Geneva, https://www.who.int/news-room/facts-in-pictures/detail/6-facts-on-obesity#:~:text=Obesity%20has%20reached%20epidemic%20proportions,%2D%20and%20middle%2Dincome%20countries.

[11] WHO (2020), Healthy diet, https://www.who.int/news-room/fact-sheets/detail/healthy-diet (accessed on 22 June 2021).

[12] WHO (2020), Physical activity, https://www.who.int/news-room/fact-sheets/detail/physical-activity (accessed on 22 June 2021).

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