(Un)healthy lifestylesEducation as a dividing line

Educational differences: a prominent dividing line

The difference between people with a high and low educational level is often regarded as a prominent social dividing line running through the Dutch population. A number of scientific studies have recently been published which centre around this education gap in the Netherlands (Bovens et al. 2014; De Lange et al. 2015; Van de Werfhorst 2015). According to these studies, educational differences are reflected in a wide spectrum of behaviours and preferences in relation to work, participation in culture (elite versus popular cultural activities), opinions and attitudes, social networks (support and friendship), political trust and demographic transitions (getting married, having children, separating/divorcing).

A more general observation based on these studies is that the differences between people with a high and low educational level are substantial and often lasting. We therefore also investigate the differentiation between people with a high and low educational level specifically with regard to health-related behaviour. Where we report educational differences, these are statistically significant; see also Acknowledgements and sources.

Why do we look at the highest attained educational level?

Scientific studies on social inequality in health or health-related behaviour often use the highest educational level attained as a determinant for someone’s social position (in addition to income and occupational status). Several good reasons can be put forward for this (Huijts et al. 2017).

1. The highest educational level attained is a relatively stable stratification characteristic in a person’s life course. It changes little after the age of 25, making it a robust and relevant predictor of all kinds of preferences, opportunities and outcomes in a person’s life.
2. The highest educational level attained is closely linked to personal qualities and characteristics which explain why people from lower social classes more often exhibit risky health-related behaviour than persons from the higher social classes (see ‘Mechanisms’ below) (Mackenbach 2010). The main mechanisms concern more limited access to financial, cultural and social resources (Gesthuizen et al. 2012; Lahelma et al. 2004; Ross & Wu 1995).
3. Establishing individual educational levels by means of a simultaneous country-comparative survey (as in the European Social Survey) is relatively reliable and valid. Alternative indicators for a person’s social position, such as income and occupational status, vary much more over time, and are often also dependent on specific regimes or structures in a country.

Mechanisms: why is education linked to health-related behaviour?

Earlier research has shown that less educated people generally report poorer health and are overrepresented among those with a less healthy lifestyle (Eikemo et al. 2017; Mackenbach 2010; Ross en Wu 1995). There is a multitude of mechanisms underlying these educational differences, which (may) explain why less and highly educated people differ from each other in terms of health-related behaviour. While theoretically these mechanisms can be readily distinguished from each other, it is also highly likely that they are mutually reinforcing. In other words, they often occur simultaneously in the same individuals (Gesthuizen et al. 2012; Mackenbach 2010; Williams 1995), leading to cumulative and more pronounced negative health effects. Nonetheless, it is important to note that the mechanisms highlighted below do not always operate to the same degree for the six habits singled out here.

Knowledge and competence gap
The first – frequently cited – explanation is the knowledge and competence gap between highly and less educated people in relation to health. Not only do highly educated people have more information and skills in relation to healthy behaviour and therefore the ability to act accordingly, but information about health is also often complex and difficult to find that it is less accessible to less educated people (Rademakers 2014).

Financial capacity
Second, the often greater financial capacity of people with a higher educational level makes it easier for them to engage in healthier behaviour: healthy choices are generally more expensive than unhealthy alternatives. Being physically active, for example, requires financial investments in club memberships and sports equipment, and healthy (organic) food is also often more expensive. The more limited financial budgets of less educated people also restrict their access to and use of healthcare facilities.

Type of employment
Third, the educational level attained often affects the type of work that people perform. People with a higher educational level often work in less physically demanding jobs and generally also enjoy better working conditions in terms of aspects such as autonomy, ambient noise, humidity and hazardous substances, which are also linked to health outcomes.

Social networks
Fourth, people’s social networks also play a role. Members of an individual’s immediate social network can offer psychological and physical support, share information and identify problems. Highly educated people generally have larger social networks, whose members more often have greater knowledge, resources and opportunities.

Cultural lifestyle differences
Fifth, are the cultural lifestyle differences associated with educational differences. Cultural tastes and preferences are closely associated with social groups, which are in turn often based on the different educational categories. Displaying group-specific cultural lifestyle behaviours can provide people with a sense of identity and strengthen their feeling of belonging to a group. Health-related behaviours (and knowledge) can also be seen as cultural expressions of specific social groups, often based on education, giving rise to the association between these behaviours and education.

Residential context
Finally, the contexts in which people live are also associated with education. Since highly educated people resemble each other in a number of ways (financially, culturally and in terms of preferences), they also often cluster in certain residential neighbourhoods with relatively good living conditions. This too can have an impact on dividing lines in terms of risky and health-related behaviours. Table 2.1 shows the distribution of the highest educational levels attained in the Netherlands in 2014.