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Can Not Going to College Be Fatal?

Depending on where you live, the answer is actually yes — and these ‘deaths of despair’ will only get worse if no one intervenes

There are many reasons I’ve never really liked the band Pink Floyd. One is that they are 87 percent boring guitar solo, but the main one is their song “Another Brick in the Wall.” From earliest childhood I have memories of being freaked out by it, especially the menace in its chorus in which sociopathic London school children chant, “We don’t need no education,” which was basically the sound of big kids surrounding you on the playground and punching their palms just before they beat you to paste. (Also, the video, if you’ve never seen it, was pretty disturbing. It had marching hammers.)

Now that I’m older and have been through school and university and a variety of workplaces myself, I’ve realized that those kids weren’t being threatening at all; they had clearly just come out of sociology class and were expressing the prevailing econometric wisdom of their time. In 1980, the year “Another Brick in the Wall” spent four weeks at the top of the Billboard chart, it looked like you really didn’t need an education to live a long and happy life.

Now, though, social scientists are broadly in agreement that opposite is true: The less education you have, the more likely you are to die an early death.

“Education has become our master social variable in understanding overall levels of socioeconomic equality, in a variety of social, behavioral and health outcomes in the U.S.,” explains Mark Hayward, professor of sociology at the Population Research Center, University of Texas at Austin. What’s more, his research indicates that for people who haven’t gone to college, how bad those health outcomes get depends, to a striking extent, on where they live. “Across all the U.S., in each individual state, the mortality and health of individuals who have a college degree is almost indistinguishable.” Whereas, “among those who have a high school or less education,” the story is very different: “There are dramatic differences in the health of people by state.”

A shocking aspect of this education-derived disparity is the fact that in the U.S. it seems amplified compared to most other high-income nations. In some parts of the country, the inequalities are so pronounced that, argues Hayward, “We’re indeed third world in many places.”

Linking Learning and Lifespans

To explain this unsettling finding, it’s first of all worth bearing in mind that it’s a statistical phenomenon that emerges on the scale of hundreds of thousands of people — it won’t necessarily line up with your own experience as an individual, or that of your Great Uncle Edward who didn’t complete high school but is still jogging and splitting logs well into his 80s.

To throw some context on a complex subject, it’s also worth circling back to the Pink Floyd era, to see how the link between mass education and population health trends became so firmly established in the first place. Back in the 1970s it was widely assumed, from tracking population-wide trends across different countries, that the key to longer lifespans was straight-up having a lot of money. The consensus was characterized in a neat income-to-outcome relationship known as the Preston curve, which suggested that the higher a country’s per capita, the healthier its people tended to be through middle age and on into their dotage. Which, intuitively, seems like very simple life-math: More money in the bank = more gym memberships + healthier diets + better access to better healthcare. A rising tide lifts all boats, right?

But no, not necessarily: As demographic analyses delved deeper into population data throughout the 1980s and 1990s, it emerged that literacy and education were usually more reliable guides to countries’ average life expectancies than economic markers like GDP or unemployment rates, which often didn’t cling to the curve so neatly — and this seemed to apply in almost every place the social scientists have looked, from India to Florida.

Debate has since raged over why and how it is that education beats out wealth in the longevity spread, and whether it’s the collective education experience itself that’s steering mortality rates, or whether it’s just a marker of some other underlying causes that are really driving the trends. Nevertheless it’s now widely accepted by sociologists, demographers and economists that the link between the number of years spent in school and the chances of enjoying good health in later life is strong, consistent and a very real thing.

In one of the most ambitious recent studies, published in April 2018, Wolfgang Lutz of the International Institute for Applied Systems Analysis in Vienna, claims to have settled the education versus income issue once and for all. Using mathematical modeling to combine data on wealth, the number of years citizens stay in education and lifespans, taken from 174 countries and ranging from 1970 to 2015, Lutz and his team found that while there was indeed a Preston-shaped correlation between lifespans and each country’s GDP, length of time in education turns out to be “a much better predictor” of how long each nation’s citizens could reasonably expect to live. What’s more, Lutz sees in his models proof that access to education is what lies at the end of the causal chain directly determining both the overall wealth and health of populations. It’s not just a contributory element greasing the gears for a smoother ride through life, he says: It’s the cause, shaping billions of lives, social inequalities and death rates, all over the world.

Hayward stops short of defining education as the primary cause, rather than a symptom, of the complex demographic forces at work. “It’s both,” he says, pointing out that the impact schooling has on broader society is unlikely to be uniform in all parts of the world, nor static over time. Social institutions aren’t external to “whatever process that we’re living in at the moment,” he says. Rather, education itself is influenced by changes in society and “gains or loses value depending on the policy and economic and social conditions of the times.”

Perhaps the most straightforward illustration of how education can shift its weight distribution in society is in the figures for college attainment in the U.S. over the past few decades. Whereas in 1980, around 17 percent of Americans aged 25 or older had a bachelor’s degree or higher, by 2017, according to the U.S. Census Bureau, that proportion had doubled to include just over a third of the adult population. For a whole drug-spiked cocktail of reasons we’ll come onto in a bit, this doubling in itself has had a dramatic negative impact on the life chances of the other 66.6 percent who didn’t go to college.

Degrees of Separation

In the U.S., the elusive and vastly complex relationship between education and health has come under intense scrutiny in recent years, because it’s at the heart of a set of findings that have unnerved many. In controversial papers published since 2015, Anne Case and Angus Deaton, a married couple who are both economics professors at Princeton, identified that, while mortality rates for middle-aged people have been in a state of steady decline in most Western nations since the 1970s, one group has been spectacularly bucking this trend since 1999: American white men and women, aged 45 to 54, who don’t have a college degree, have been dying in ever greater numbers. According to Case and Deaton, what’s been fueling the death-rate spike for this group has been a surge in what they call “deaths of despair” — fatalities that are the result of suicide, alcoholism or drug overdoses.

Their findings have thrown a harsh light on the extent of the destruction wrought by America’s opioid crisis. According to estimates Hayward has been working on that are yet to be published, for all adults aged 25 to 89, the disparity in life-expectancies between the highly educated and the less so in the U.S. “is widening very fast, even within a seven-year period between 2010 and 2017. The only people who gained in life-expectancy were people with advanced college education. All college non-completers lost life-expectancy in that seven-year period. And among people with high school and less, 70 percent of that drop was due to drug-poisoning deaths; 50 percent of ‘some college’ was due to drug-poisoning deaths.” Among the larger section of the population that didn’t go to college, he concludes “the concentration of drug-poisoning deaths — not so much alcohol, and not so much suicide — is phenomenal.” Yet, despite its startling rise among all these groups, drug poisoning remains “a very rare cause of death among people with college education.”

Aside from the sheer number of lives being lost (in Case and Deaton’s estimation, the upward spike in mortality they identified in the 45-to-54-year-old Caucasian group represents around half a million Americans who might have lived into old age if previous trends had continued), one of the most striking things about all of this research is where it draws the in-or-out rope. Across the board, it’s a college degree, not a high school degree, that you need to escort you out of the early-death danger zone and into the lower-risk groups. It starts to make it seem like everyone’s life is, on some level, a version of Good Will Hunting. How did the educational bar get to be so high? And how is it that, in marking out the terrain for arguably the most fundamental inequalities of all — health, wellbeing, how long we get to live — a college education seems so much more important than those more familiar groupings of race, gender, socioeconomic class?

The answer, it turns out, is the thing that was supposed to ease inequalities in society and improve life prospects for us all: Technology. Stretching back to the last decades of the 20th century, says Hayward, people’s progression through education “has been incredibly tied to the transition to the labor market, and increasingly strongly tied to gaining a toehold in the economy.” That labor market, meanwhile, along with the economy as a whole, has been radically transformed by technological advances — a process that has sped up enormously since the turn of the century. “The rapid rise of technology,” says Hayward, has “shaken up in complex ways how work is organized and where it’s located. And so you have a process of social and technological change where education — especially advanced education — has become an increasingly valuable resource.”

To put it another way, many are finding that in a digital-led economy, even low-paid or entry-level jobs require the kind of specialized learning, intellectual confidence or technical knowhow a college course provides. As Case put it in a 2017 interview with the Washington Post: “In a previous generation, you had the chance of getting a good job with only a high school degree — a job where you could move up the ladder, where… as you grew older, your wages would rise. A lot of those jobs are gone — jobs with health benefits, jobs with on-the-job training. And without that kind of a job, it’s much harder.”

Goodies: For Graduates Only

The downstream downsides of not going to college, though, aren’t confined to opioids and Case and Deaton’s other deaths of despair. As study after study has indicated, not pursuing education beyond high school carries a greater risk of developing all sorts of other physical maladies down the line, which, on the face of it at least, seem more obscure in their connection to people’s personal economic circumstances — from heart disease and strokes to dementia and a host of lifestyle-related conditions such as diabetes and a range of cancers.

The reasons for this are, to use a term popular among sociologists, “multidimensional.” But for Hayward, many of the pathways to poor health can again be traced back to the technological revolution. “The consequences [of rapid technological change] are that the ‘basket of goodies’ is increasingly concentrated among the very well educated. They have everything. They have every kind of resource. They make decisions and they confront life in ways that are completely different than people with less or low education. They have knowledge, they have income, they have social networks; they have a variety of resources they can draw on to garner health advantage.”

One of those resources is, of course, better access to health care through jobs and income. But many of the other social assets research has pointed to, and which have been shown to have a background causal effect on health and life-expectancy, are perhaps more surprising. Marriage is a big one. Research suggests that people who are married tend to be healthier (and, apparently, even grip harder) than those who aren’t, and “in the U.S.,” says Hayward, “college-educated people marry other college-educated people.” These couples’ children will also be much more likely to go to college, passing their varsity health bonus down to the next generation like genetic immunity to a disease. At the other end of the education spectrum, meanwhile, “your chances of getting a divorce are much higher, and so are the chances of never marrying.”

Another “goodie” that’s easier for the college-educated to acquire, and which has been shown to have positive impacts on our bodies later in life, is developing strong social support networks among friends, colleagues and neighbors. Another is “creative productivity” — being happy in your occupation, essentially. Yet another is enjoying a sense of control or agency in your life — working for yourself, for instance, or occupying a senior position in a corporate pecking order, which reduces day-to-day stress loads that can add up to grim outcomes. When you line them up, the list of side benefits that seem to flow from four years on campus really does seem like the most potent multi-vaccine you can give yourself.

By contrast, the horizons for the less educated are much narrower. “When you have people at the low end of education, they’re much more constrained in human agency, their networks are confined to people that are like themselves, which doesn’t provide them any additional resources; they have no income, they have no choices, they have a lot of constraints. Their choice set is much less.”

Why Life Is Shorter in Some States   

So that’s how a college experience can play a role in extending life: The greater power it confers on people in making life choices that ultimately translate into healthier outcomes. But according to Hayward, humans acting to seize their opportunities is only one side of the education-health equation. The other is to do with the legislative and institutional forces that shape and limit people’s choices in the first place. It’s this social framework that Hayward sees as responsible for the stark health discrepancies in people who didn’t go to college that exist from state to state.

And where is it that those with high school education or less are faring worst? The American South, he says, “has become much more homogeneous in the poor health of its population,” while “there is a lot of poor health in the Midwest where it didn’t used to be. Kansas… used to have really excellent life expectancy, and now it has dropped precipitously.” At the other end of the scale, “The Northeast part of the United States is very healthy — they have very strong social insurance programs. So is the West Coast.”

These disparities aren’t fixed, he warns. The health tables have moved around over time, and the widening of disparities, he says “has been unfolding, probably since the 1980s when the federal government started to devolve policies back to the states, so that the states became more responsible for their social insurance programs.”

Among the social policies that have been studied and linked to positive effects on health figures include: Raising the state minimum wage, which reduces early deaths from heart disease; Earned Income Tax Credit payments, which appear to “lower the odds of disability for women and men in later life”; and cigarette taxes, which, well, duh.

Hayward’s key finding in terms of education is that such government interventions at the state level are effective, but only for those without a college degree; for the college-educated they have barely any impact at all on their overall health prospects. As his collaborator Jennifer Karas Montez put it in describing their recent research on states’ variance, “A college degree is like a personal firewall. One can take it just about anywhere and it will have similarly large benefits for health.” For the two-thirds of the population without one, meanwhile, it could be making all the difference in the world.

Hayward’s conclusions are of course likely to be unpalatable for many, but they’re shared by others working in the field of population research. In explaining to the Washington Post why his and Anne Case’s “deaths of despair” trend doesn’t seem to be replicated in Western Europe, Angus Deaton pointed to the fact that “the safety net is enormously more generous in Europe,” while feeling the need to insist: “I’m not a left-wing nut pushing for single-payer! It’s not because I like socialized medicine.”

For his part, Hayward sees the potential human costs as far too high to let ideology stand in the way of further research into how the education divide is playing out. “The point isn’t to point the blame at any one person or party,” says Hayward. “It’s to say that we have an enormous problem confronting us. There are different policy strategies of going after this problem, but it is a problem. And it’s affecting millions of people’s lives. In our case, this inequality problem shows no sign of leveling off — it continues to accelerate. Not all boats are rising here. Some boats are sinking.”

As technology marches on, like those terrifying hammers in the Pink Floyd video, the bar to finding fulfilling employment is ratcheting up higher and higher, and so the various impacts of mass exclusion fan out further still to create inequalities in almost all corners of life. In a 21st-century society saturated with technologies designed to mitigate illness — from neuroimaging scans to smear tests to mindfulness apps — and an online environment that’s flooded with information on health and well-being, this seems astounding. But it appears to be where we are. As Hayward points out, “When you don’t have the way to keep body and soul together, and you’re increasingly buffeted by factors that you can’t control, it’s going to show up in your body.”

Even so, he’s cautiously optimistic. “We see a lot of downward change within 17 to 20 years, but we can reverse a lot of that.” After all, once you descend from the blustering weather systems of staggeringly huge population numbers to the level of individuals just getting on with their lives, education stops being destiny. Armed with a greater understanding of how policy interventions, at both state and federal levels, can improve health prospects for everyone, Hayward believes authorities can tame the opioid epidemic, by getting the word out to people in “places that aren’t as vulnerable yet, but could be… working within a social-network context in spreading information. We did this with the HIV crisis in the U.S.; we did it very effectively in stemming the tide. We can do this with the opioids, too.”