A Theory of Health Differences

Link to Google Doc

This is another post with a loose theory, expect some rambling and some speculation. I also advise you to read my previous post first as I reuse some concepts and sources in this post.

In my last post, A Framework of Social Status , I laid forth a framework for thinking about social status. It seems as if social status is an important phenomenon and I believe that it can be used to explain things that we, so far, has had trouble explaining. During my vacation I spoke and thought about social status with friends and family. At the same time, the pandemic is raging on and evidence from the US shows that people with more education are more willing to get the vaccine.

These two factors led me to speculate a little about differences in health among groups with different levels of education. In my last post, I discussed the book Deaths of Despair, which details the deteriorating health conditions for white Americans with no college education. Contrary to the authors of that book, I believe that status is an important factor in understanding that phenomenon. Still, relative levels of status may be important for trends as that one but they cannot really explain why obesity, mental health, and general health is better among the higher educated than the less educated.

To get a grip of the matter, we can look at the literature and some of the possible explanations discussed. There is a robust link between education and obesity, less education is linked to a higher probability of obesity. Many other studies find that less education is related to a higher probability of chronic pain. The reasons for these differences among educational levels are debated though, and they are most likely manifold. Lower levels of education means lower income, which leads to not being able to afford more expensive and more healthy alternatives. However, some studies find stronger links between education and pain rather than between income and pain.

It seems likely that incomes are important, since cheaper processed food is less healthy. However, it does not seem to tell the whole story. Another theory is that education increases health literacy, which makes individuals make better choices related to their health. Health literacy positively affects health, and it is also correlated with education. More education means more health literacy, which leads to better health. The learning hypothesis, which I call this explanation, posits that we learn how to take care of ourselves in school.

Education is clearly related to better health, but in a very different way than by increasing health literacy. I do not believe that school teaches its students to be better at thinking about health, and I do not think that learning “critical thinking” is important enough to be healthier. I am also not a fan of thinking that stupidity or the inability to understand is the reason of any net-negative behaviors. Instead, my theory is that education is where people learn high status behaviors. Schools are filled with high status individuals, especially as you reach into higher education. These individuals exhibit behaviors that are, on net, healthier. We humans tend to emulate the behavior of individuals with higher status than ourselves, which means that people who spend more time in school emulate more healthy behaviors.

This theory would predict a number of things. First, the theory would predict that people who stay longer in school to be more healthy, this we already know is true. Contrary to the learning hypothesis, which would see increases in the years where students have mandatory PE, this theory allows for increases in health even after that. This is also what is seen in the data, this Dutch study finds that health is better for all levels of education (even though the effect is larger for the early stages of education, which points to a combination of my theory and learning in PE). It predicts that higher status people stay longer in school, research indicates that parents’ educational level and income predicts more education for the children. Most importantly, it predicts that higher status people are more likely to engage in healthy behaviors. This is the hardest proposition to gauge, since very few studies look at status and health. But, looking at studies on the relation between income and exercising shows that higher income is related to more exercising. Other studies find that eating habits also change with social class, which also indicates that status is correlated with healthier behaviors.

In the previous post I mentioned a paper that looked at the cultural preferences of high status people. In the paper they argue that cultural preferences are learned in both the family and in the school. It seems likely that this is the case for behaviors related to health as well. This means that some of the difference in health outcomes comes from the family, and of course what family you are raised in significantly affects how many years you decide to spend in school. The causal effects may therefore be hard to untangle. However, the literature on substance use among adolescents has found that peers are more important than parents in influencing behavior. This is likely true for healthy behaviors as well, which means that spending time in school is more important than being born in a specific family when picking up healthy behaviors.

So why cannot people with less education just emulate the behavior of high status people anyway? I think this comes down to us humans being bad at copying behavior if we are not in the immediate environment. Just imagine trying to become a vegan in a group where everyone exclusively eats meat, it is harder than one thinks since you risk getting left out of the group. Many lower status individuals may not be exposed to high status individuals, which means that their only exposure to elites may be through media, where elites are often portrayed as decadent and not caring about health. It may also be related to income as well, higher status people generally have a higher disposable income and if healthy behavior is more expensive than unhealthy behavior that may explain some of it.

Overall, testing this theory further could give insights into what drives behavioral changes, how one can make healthier choices, and it may even make the population healthier over time. I do think that this is a plausible explanation, but I also think that it likely that many other factors also matter. Such factors can be job market safety, income, and lower discount rates in educated individuals.

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