Tracking Health Inequalities from High School to Midlife

Abstract

Educational gradients in health status, morbidity, and mortality are well established, but which aspects of schooling produce those gradients is only partially understood. We draw on newly available data from the midlife follow-up of the High School and Beyond sophomore cohort to analyze the relationship between students' level of coursework in high school and their long-term health outcomes. We additionally evaluate the mediating roles of skill development, postsecondary attendance and degree attainment, and occupational characteristics. We find that students who took a medium- to high-level course of study in high school have better self-reported health and physical functioning in midlife, even net of family background, adolescent health, baseline skills, and school characteristics. The association partially operates through pathways into postsecondary education. Our findings have implications for both educational policy and research on the educational gradient in health.

Figure 1

Conceptual Model

Figure 2. Estimated Population Distribution of Health Status by Course-Taking Pattern

Notes: Figure displays the estimated distribution of health status for two of the course-taking levels from an ordinary least squares regression, controlling for background and baseline skills. “LOW” indicates taking all low-level courses, and “HIGH” indicates taking all high-level courses. The “Observed” lines are health status by the course-taking pattern reported on student transcripts. The “Predicted” lines are health status if all high school students took at least the highest course-taking level that they were prepared to take based on their sophomore year skills. The mean is the population mean from table 1.

Figure 3. Estimated Population Distribution of Physical Functioning by Course-Taking Pattern

Notes: Figure displays the estimated distribution of physical functioning for two of the course-taking levels from an ordinary least squares regression, controlling for background and baseline skills. “LOW” indicates taking all low-level courses, and “HIGH” indicates taking all high-level courses. The “Observed” lines are physical functioning by the course-taking pattern reported on student transcripts. The “Predicted” lines are physical functioning if all high school students took at least the highest course-taking level that they were prepared to take based on their sophomore year skills. The mean is the population mean from table 1.