Giving everyone the health of the educated: an examination of whether social change would save more lives than medical advances

Abstract

Objectives: Social determinants of health, such as inadequate education, contribute greatly to mortality rates. We examined whether correcting the social conditions that account for excess deaths among individuals with inadequate education might save more lives than medical advances (e.g., new drugs and devices).

Methods: Using US vital statistics data for 1996 through 2002, we applied indirect standardization techniques to estimate the maximum number of averted deaths attributable to medical advances and the number of deaths that would have been averted if mortality rates among adults with lesser education had been the same as those among college-educated adults.

Results: Medical advances averted a maximum of 178193 deaths during the study period. Correcting disparities in education-associated mortality rates would have saved 1369335 lives during the same period, a ratio of 8:1.

Conclusions: Higher mortality rates among individuals with inadequate education reflect a complex causal pathway and the influence of confounding variables. Formidable efforts at social change would be necessary to eliminate disparities, but the changes would save more lives than would society's current heavy investment in medical advances. Spending large sums of money on such advances at the expense of social change may be jeopardizing public health.

FIGURE 1—

Age-adjusted mortality rates in the United States: 1900–2003. Note. Data were derived from the National Center for Health Statistics; specific database sources are available as an online supplement to this article.

FIGURE 2—

Deaths potentially averted per year in the United States by medical advances and by eliminating education-associated excess mortality: 1996–2002. Note. The graph demonstrates that elimination of education-associated excess mortality (white bars) would save considerably more lives than would medical advances (black bars). Cumulatively during 1996–2002, elimination of education-associated excess mortality would avert 1 369 335 deaths, whereas medical advances would avert 178 193 deaths. The estimate of deaths averted by eliminating education-associated excess mortality applies only to adults aged 18–64 years, whereas deaths averted by medical advances include all age groups (see the online supplement to this article for more information).