The effect of low graduation rates on mortality

Poverty kills. Across societies throughout history, markers of social marginalization, such as poverty, racial and ethnic marginalization, unequal access to education, and socioeconomic segregation, have long been shown to predict higher likelihoods of disease and shorter lifespans.  The mechanism undergirding this relationship is relatively straightforward: Access to information and resources. The poor, uneducated, and marginalized lack access to both knowledge about how to protect themselves from disease, as well as the resources to do so.

Consider the epidemic of type II diabetes in the South Bronx, for example, where nearly 1 in 5 have the disease. Type II diabetes is especially prevalent among low-income African-American women who are high-school dropouts. Surveys suggest that women fitting this demographic haven’t been educated about the types of foods they should eat to allay the onset of diabetes, or its symptoms. But even if armed with this education, the South Bronx is a “food desert”, meaning that there are few outlets that sell high quality, nutritious foods—so these women wouldn’t be able to buy the foods they needed, anyway.

That the poor die young is nothing new—but the sheer scale of the influence of social marginalization on health and disease has been unclear. This is where a recent study published by my research group in the American Journal of Public Health may have some purchase. The researchers in my group set out to tally, in terms of deaths in one year nationwide, the effects of social “defects”, like low high school graduation rates, racial segregation, individual and neighborhood poverty, low social support, and income inequality. They found that failure to graduate high school was responsible for 245,000 deaths in the year 2000—that’s more than the number of deaths by heart attack, the nation’s #1 killer! Similarly, racial segregation took as many lives as stroke, and low social support killed as many people as lung cancer. The implication? That ensuring that young Americans graduate high school, for example, could save as many lives as eliminating heart attacks—not to mention all the other positive effects it might have on their lives.

  • Anonymous

    Abdul, sounds like a fascinating study! For those of us who haven’t read it in depth yet, how did you go about controlling for correlation and causation?

    • Abdul El-Sayed

      I, personally, wasn’t involved in the study, but several of my colleagues were involved. The study was based on a review of observational analyses–meaning the studies weren’t able to assess pure causality, per se, although each was adjusted for potential demographic and social confounders. It’s also important to note that a single death can be attributable to multiple causes–so low education may operate through poor diet and low exercise, itself operating through obesity, operating through heart disease to cause a death. In that sense that death can be attributed to every factor on the causal axis–education, diet, exercise, obesity and heart disease. However, from a sustainability perspective, it’s most efficient/effective to intervene as early on the causal axis as possible, as causes branch at each level. So, low education, for example, may cause low exercise and poor diet, as noted above, but it also increases smoking risk, risk for heavy alcohol and drug abuse, etc. So improving education will have purchase against all of these factors and is more efficient than intervening against each factor on its own.

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