LINKS BETWEEN EDUCATION AND HEALTH
There is growing evidence that education leads to more than just better employment opportunities and higher income. International research has clearly established that higher levels of educational attainment are also associated with improved health outcomes (ABS & AIHW 2005). For example, strong positive correlations have been found between parental education, particularly that of the mother, and child health. It has also been shown that higher levels of educational attainment are associated with better self-assessed health and physical functioning, and lower levels of morbidity and mortality (Albano et al 2007; Ross & Wu 1995).
However, while there is general acceptance of a positive association between education and health, the full extent of this relationship has yet to be explained (see box 3.8, below). Likewise, while there is some evidence to suggest that the effect of education on health is similar for Aboriginal and Torres Strait Islander people (Biddle 2005; Gray & Boughton 2001), there has been relatively little research overall.
3.8 EXPLAINING THE LINKS BETWEEN EDUCATION AND HEALTH
While the positive association between education and health has been well established, the explanations for the association have not. Generally, the most common explanations fall into two main categories. Firstly, education may lead to better health outcomes through increasing a person’s health-related knowledge and information, or their ability to make efficient use of such information. Doing so may increase the likelihood of a person engaging in positive health behaviour (e.g. exercising, regular health check-ups), or alternatively not engaging in behaviour likely to be harmful to one’s health (e.g. smoking).
Furthermore, those with higher education levels are more likely to be employed and generally have access to better working conditions and higher incomes. These factors may in turn affect health by allowing a person to avoid some of the negative health consequences of 'low status' jobs, or through increasing the ability to pay for health or health related products, such as medication, health insurance, specialist services and so on. Well educated people may also feel a greater sense of control over their lives and their health, and have higher levels of social support.
Secondly, the association between education and health may be partly explained by the fact that healthy individuals are better able to undertake education in the first place. A child's health has a powerful impact on whether or not they attend school and on their ability to learn and participate in school activities. Therefore children with disability or chronic health conditions may be at risk of not completing their education (for more details on the impact of health on education, see Chapter 3 in the 2005 edition of this report). Similarly, poor health could manifest itself through relatively low life expectancy, thereby not allowing a person to enjoy the benefits of education for as long as they otherwise would. Poor health may also restrict a person’s ability to make use of their enhanced earnings power derived from their education. Source: Biddle 2005; Kennedy 2003; Ross & Wu 1995 |
Health and education correlations from the 2004-05 NATSIHS
This section explores the relationship between highest level of schooling and selected health indicators for Indigenous people aged 18 years and over using the results from the 2004-05 NATSIHS. However, it is important to note that the interactions between educational attainment and health outcomes are complex and are difficult to measure in household surveys. So while the NATSIHS can provide insights into the associations between school completion and health (and vice versa), it cannot determine the causal pathways that underlie them.
Furthermore, both level of education and health status are strongly related to age, meaning that younger people are much more likely than older people to be in good health and to be well educated. For example, in 2004-05, those aged 18-34 years comprised 71% of all Indigenous people who had completed Year 12 and 62% of all Indigenous people who reported excellent/very good health, although this age group represented slightly less than half the total adult population. Therefore to reduce the effect of age, the following analysis focuses on two broad age groups: young adults aged 18-34 years and older adults aged 35 years and over.
Results from the 2004-05 NATSIHS show that educational attainment was positively associated with health status. Table 3.9 shows that young Indigenous adults (aged 18-34 years) who had completed Year 12 were more likely than those who had left school at Year 9 or below to rate their health as excellent or very good (57% compared with 45%), and were less likely to rate their health as fair or poor (10% compared with 16%). They were also around half as likely to report high/very high levels of psychological distress in the last four weeks (19% compared with 35%). A similar pattern of association between educational attainment and health outcomes was also observed for Indigenous people aged 35 years and over.
The likelihood of engaging in health risk behaviours also decreased with higher levels of schooling. In 2004-05, young adults who had completed Year 12 were half as likely as those who had completed Year 9 or below to regularly smoke and to consume alcohol at long-term risky/high risk levels. In non-remote areas, Indigenous young people with higher educational attainment were also less likely to be sedentary or engage in low levels of exercise, and to have no usual daily intake of fruit or vegetables (table 3.9). However, among Indigenous people aged 35 years and over, only rates of smoking and low fruit consumption significantly decreased with higher levels of schooling.
3.9 SELECTED HEALTH CHARACTERISTICS OF INDIGENOUS PERSONS, by highest year of school completed(a) - 2004-05 |
|  |
| | | | 18-34 years | 35 years and over | |
| | | | Year 12 | Year 10/11 | Year 9 or below(b) | Total(c) | Year 12 | Year 10/11 | Year 9 or below(b) | Total(c) | |
| |
| Self-assessed health status | | | | | | | | | | |
| Excellent/Very good | % | (d)57.4 | 48.5 | (d)44.8 | 50.6 | (e)38.9 | 35.8 | (e)21.2 | 29.4 | |
| Good | % | 32.9 | 36.6 | 39.4 | 36.0 | 34.4 | 40.2 | 34.1 | 36.6 | |
| Fair/poor | % | (d)9.7 | 14.8 | (d)15.7 | 13.3 | (e)26.7 | 24.0 | (e)44.7 | 34.1 | |
| Long-term health conditions | | | | | | | | | | |
| Has a long-term health condition | % | (d)75.5 | 70.4 | (d)68.2 | 71.6 | 89.1 | 88.7 | 92.1 | 90.4 | |
| | Diabetes/high sugar levels | % | *1.9 | 3.3 | *3.5 | 2.8 | (e)15.7 | 11.5 | (e)25.9 | 18.8 | |
| | Eyes/sight problems | % | (d)33.8 | 24.0 | (d)18.5 | 26.0 | (e)63.9 | 59.3 | (e)75.9 | 67.7 | |
| | Ear/hearing problems/diseases | % | (d)8.7 | 10.3 | (d)15.7 | 11.0 | 20.0 | 15.9 | 21.8 | 19.2 | |
| | Heart and circulatory problems/diseases | % | (d)5.4 | 9.1 | (d)10.5 | 8.2 | (e)27.0 | 23.8 | (e)40.9 | 32.3 | |
| | Asthma | % | 18.0 | 17.2 | 13.8 | 16.7 | 15.8 | 14.2 | 18.1 | 16.3 | |
| | Arthritis | % | 5.4 | 5.9 | 5.7 | 5.7 | 24.0 | 23.2 | 30.7 | 26.8 | |
| | Back pain/symptoms | % | 14.8 | 20.9 | 19.7 | 18.6 | 28.3 | 28.1 | 27.0 | 27.7 | |
| | Osteoporosis | % | np | np | np | * - | **(e)0.8 | *2.2 | (e)4.0 | 2.9 | |
| | Kidney disease | % | **0.9 | *2.4 | *2.1 | 1.8 | **(e)0.8 | 2.7 | (e)5.9 | 3.9 | |
| Does not have a long-term health condition | % | (d)24.5 | 29.6 | (d)31.8 | 28.4 | 10.9 | 11.3 | 7.9 | 9.6 | |
| Health risk factors | | | | | | | | | | |
| Current daily smoker | % | (d)33.8 | 58.7 | (d)70.1 | 53.0 | (e)35.4 | 50.4 | (e)48.2 | 47.4 | |
| Long-term risky/high risk alcohol consumption(f) | % | (d)9.8 | 19.8 | (d)20.5 | 16.6 | 18.1 | 16.4 | 15.8 | 16.3 | |
| Short-term risky/high risk alcohol consumption(f) | % | (d)13.8 | 24.5 | (d)27.3 | 21.6 | *12.8 | 17.4 | 18.0 | 17.1 | |
| Overweight/obese(g) | % | 50.0 | 52.2 | 54.7 | 51.9 | 73.1 | 67.7 | 67.1 | 68.2 | |
| Sedentary/low levels of exercise(h) | % | (d)69.0 | 74.8 | (d)79.6 | 73.5 | 75.0 | 81.0 | 84.3 | 81.6 | |
| No usual daily fruit intake | % | (d)11.4 | 18.7 | (d)19.5 | 16.5 | (e)5.1 | 12.8 | (e)15.9 | 13.3 | |
| No usual daily vegetable intake | % | *(d)3.5 | 6.1 | (d)10.1 | 6.1 | *4.6 | 3.1 | 7.0 | 5.1 | |
| High/very high psychological distress(i) | % | (d)19.2 | 28.1 | (d)34.5 | 26.5 | (e)20.9 | 26.0 | (e)31.0 | 27.7 | |
| Indigenous persons aged 18 years and over | no. | 41 100 | 57 200 | 27 200 | 125 600 | 17 100 | 52 600 | 62 100 | 131 800 | |
| |
| * estimate has a relative standard error of 25% to 50% and should be used with caution |
| ** estimate has a relative standard error greater than 50% and is considered too unreliable for general use |
| - nil or rounded to zero (including null cells) |
| np not available for publication but included in totals where applicable, unless otherwise indicated |
| (a) Excludes persons still attending secondary school. |
| (b) Includes persons who never attended school. |
| (c) Includes 'Highest year of school completed not stated'. |
| (d) Difference between Year 12 and Year 9 or below for persons aged 18-34 years is statistically significant. |
| (e) Difference between Year 12 and Year 9 or below for persons aged 35 years and over is statistically significant. |
| (f) See Glossary for more information. |
| (g) Proportions are calculated excluding 'Body mass index unknown'. |
| (h) Non-remote areas only. |
| (i) In the last four weeks. |
| Source: ABS 2004-05 NATSIHS |
Education level has also been shown to be associated with long-term health conditions, particularly heart disease and diet-related illnesses (MCEETYA 2001). In 2004-05, Indigenous people aged 35 years and over who had completed school to Year 12 were around half as likely to report having diabetes or cardiovascular disease as those who had left school at Year 9 or below. They were also less likely to report eye/sight problems, osteoporosis and kidney disease.
Poor health among young people may also impact on their opportunity to attend and succeed at school. As outlined in the 2005 edition of this report, health conditions such as otitis media (middle ear infection) and poor nutrition have been shown to negatively affect educational attainment. In 2004-05, young Indigenous people who had left school at Year 9 or below were around twice as likely as those who had completed Year 12 to have ear/hearing problems and heart/circulatory diseases. These conditions - if present from childhood - may have had a significant impact on both school performance and attendance. However, because the NATSIHS did not collect information on age of onset of chronic conditions, causality cannot be determined.
Additional effects of employment and income on health
Overall, half (51%) of Indigenous people aged 18-34 years reported excellent or very good health in 2004-05. This proportion was higher among those who had completed Year 12 ( 57%) and among those who were employed (55%). Just under two-thirds (63%) of people who had completed Year 12 and who were also employed reported excellent/very good health. This proportion was only slightly higher among those who had completed Year 12, who were employed and who had access to higher household incomes (64%) (table 3.10).
3.10 SELECTED SOCIOECONOMIC INDICATORS, Indigenous persons aged 18-34 years with excellent/very good self-assessed health - 2004-05 |
| |
| Excellent/very good health | |
| % | no. | |
| |
| Completed Year 12 | 57.4 | 23 600 | |
| Employed | 55.1 | 38 400 | |
| Household income in third quintile or above(a) | 57.8 | 20 600 | |
| Completed Year 12 and employed(b) | 62.9 | 15 600 | |
| Completed Year 12 and household income in third quintile or above(c) | 64.1 | 11 600 | |
| Completed Year 12 and employed and household income in third quintile or above(b)(c) | 65.5 | 11 200 | |
| Indigenous persons aged 18-34 years with excellent/very good health | 51.3 | 64 000 | |
| |
| (a) Based on equivalised gross household weekly income. |
| (b) Excludes persons for whom information on highest year of school completed was not known. |
| (c) Excludes persons for whom information on highest year of school completed and/or household income was not known. |
| Source: ABS 2004-05 NATSIHS |
The 2004-05 NATSIHS used a modified five-item version of the Kessler Psychological Distress Scale (known as the K5) to measure non-specific psychological distress. A high score indicates that the person may be experiencing feelings of anxiety or depression on a regular basis, whereas a low score indicates that the person is experiencing these feelings infrequently or not at all. In 2004-05, around three-quarters (73%) of all Indigenous people aged 18-34 years reported low levels of psychological distress in the four weeks prior to interview. Again, the proportion of Indigenous people reporting low levels of psychological distress was higher among those who had completed Year 12 (81%) and those who were employed (79%), but was only slightly higher for those who met both criteria (83%). The rate did not change significantly with inclusion of the income criterion (83%) (table 3.11).
3.11 SELECTED SOCIOECONOMIC INDICATORS, Indigenous persons aged 18-34 years with low levels of psychological distress - 2004-05 |
| |
| Low psychological distress(a) | |
| % | no. | |
| |
| Completed Year 12 | 80.6 | 32 800 | |
| Employed | 79.3 | 54 800 | |
| Household income in third quintile or above(b) | 79.7 | 28 300 | |
| Completed Year 12 and employed(c) | 82.7 | 20 400 | |
| Completed Year 12 and household income in third quintile or above(b)(d) | 82.5 | 14 900 | |
| Completed Year 12 and employed and household income in third quintile or above(b)(d) | 83.1 | 14 200 | |
| Indigenous persons aged 18-34 years with low levels of psychological distress | 73.0 | 91 100 | |
| |
| (a) In the four weeks prior to interview. |
| (b) Based on equivalised gross household weekly income. |
| (c) Excludes persons for whom information on highest year of school completed was not known. |
| (d) Excludes persons for whom information on highest year of school completed and/or household income was not known. |
| Source: ABS 2004-05 NATSIHS |
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