Measuring education in the context of health inequalities

Socio-economic inequalities in a wide range of health outcomes are pervasive and enduring. Most often, the association between socio-economic indicators and health is inversely graded (commonly known as social gradients in health) so that the higher the socio-economic position (SEP), the lower is the rate of morbidity and mortality. SEP is a broad concept capturing resource- and prestige-based measures. To date, educational level/attainment has been commonly used as an indicator of SEP in health inequalities research due to general acceptance that education is easy to measure and unlikely to be affected by diseases that begin in adult life.3 Of note, early-life health gradients in education (i.e. health selection hypothesis or reverse causality) might also exist and needs to be considered. Education is less prone to non-response error compared with income or wealth as SEP indicators. In most nations, education shapes the future occupational position and earning potential of individuals. However, it is important to keep in mind that in this context, education is only a ‘proxy’ or a probabilistic indicator of social class, status or income. (author abstract)