by Kim Krisberg

A recent report again confirms what comes as no surprise to public health practitioners: that income and education are inextricably tied to the opportunities for better health and longevity.

In mid-May, the Centers for Disease Control and Prevention released its yearly report on Americans’ health, “Health, United States, 2011.” This year’s report included a special section examining the links between socioeconomic status and health. It’s another reminder that good health is as much — or even more — tied to what goes on outside a doctor’s office rather than what goes on inside. As Dr. Margaret Chan, director-general of the World Health Organization, so eloquently said in 2008:

The social conditions in which people are born, live, and work are the single most important determinant of good health or ill health, of a long and productive life, or a short and miserable one.

…the great discrepancies that occur along the social scale — from marginalization and deprivation to privilege and power — are the main reason for the vast differences seen throughout the world in health outcomes and life expectancy.

According to the recent CDC report, socioeconomic status — which includes income, wealth, education and access to goods, services and knowledge — impacts, well, just about everything. Some highlights:

• From 2007 to 2010 in households in which the head of the household had less than a high school education, 24 percent of boys and 22 percent of girls were obese. In households in which the head of household had a bachelor’s degree or higher, obesity prevalence was 11 percent for boys and 7 percent for girls. (Obesity contributes to increasing rates of more than 30 diseases and counts for more than a quarter of health care costs, according to the Trust for America’s Health.)
• In the decade between 1996 and 2006, the life expectancy gap between those with less than a high school education and those with a bachelor’s degree or higher got wider. On average in 2006, a 25-year-old man without a high school diploma had a life expectancy more than 9 years less than his college-educated counterpart. For women, the gap was 8.6 years.
• Income and education impact a person’s use of and access to effective preventive services as well. Women with lower incomes and education levels are less likely to receive prenatal care or mammograms. The percentage of kids who receive recommended immunizations rises along with a mom’s education and income level. And elderly adults without a high school diploma are less likely to receive a flu or pneumococcal vaccine.
• Asthma prevalence is highest among children living in poverty, who are also more likely to be diagnosed with attention deficit hyperactivity disorder. In 2010, the percentage of children who visited a dentist in the previous year rose along with family income.
• When it comes to mental health, depression among adults 20 years old and older who were living below the poverty level was more than four times higher than their richer counterparts.
• Adults with family incomes below 200 percent of the poverty level were also more likely to forgo or delay seeking out needed medical care. This disparity was documented among all racial and ethnic groups.

In an interview with USA Today, report author Amy Bernstein, with CDC’s National Center for Health Statistics, said: “Highly educated people tend to have healthier behaviors, avoid unhealthy ones and have more access to medical care when they need it. All of these factors are associated with better health.”

To download the more than 500-page CDC report, visit www.cdc.gov/nchs/hus.htm.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for a decade.