(Un)healthy lifestylesEducation as a dividing line

Educational differences in health-related behaviour in Europe

Figure 4.1 shows the educational differences in these six health-related behaviours in Europe. You can select the various indicators by clicking on the map.

Smoking
Portugal proves to be the only country where people with a high educational level smoke more than people with a low educational level; in all other countries this unhealthy habit is more popular among those with the lowest educational level. The Netherlands occupies a midway position in terms of the gap between people with a low and high educational level, with a disparity of 15.8 percentage points. The relatively wide educational differences in smoking in Belgium and Estonia are striking, with the gap reaching as much as 23 percentage points or more. We find an education gap for smoking in virtually all countries in Europe, with smoking being an unhealthy lifestyle expression that is concentrated mainly among people with a low educational level across Europe.

Alcohol consumption
When it comes to alcohol consumption in Europe, the Netherlands occupies a middle position in terms of inequality between those with high and low educational level in drinking alcohol regularly. In most countries, those with higher educational levels drink most often, but there are six countries (especially Portugal and Lithuania) where alcohol consumption is more frequent among the lower-educated.

The gap is particularly wide in Central European countries such as Belgium, Germany, France and Switzerland; alcohol consumption in these countries is relatively high among those with the highest educational level, and the education gap rises to over 10 percentage points. Strikingly, regular alcohol consumption by those with a high educational level is the highest of all European countries in the Netherlands and Belgium.

Overweight
A comparison of educational differences in relative body weight (BMI) shows that the lowest-educated in the Netherlands have a BMI which is 1.6 points higher on average than those with a higher educational level. A similar substantial difference is found in virtually all European countries, ranging from 1.1 to 3.0 BMI points. The BMI differences by education are greatest in Central and Eastern European countries (Slovenia, France and Lithuania).

Eating fruit and vegetables
There is wide international variation in the educational differences in consumption of fruit and vegetables. In Lithuania, for example, daily consumption of fruit is extremely unequally distributed across educational groups, while in Germany and Portugal there is virtually no difference between those with high and low educational levels. In the Netherlands, too, the differences between educational groups are negligible: 68% of the lowest-educated eat fruit daily, compared with 74% of those with a high educational level.

The picture is more uniform for daily consumption of vegetables: everywhere in Europe, daily consumption of vegetables is greater among the more highly educated. Once again, the educational differences are greatest in Lithuania. The Netherlands occupies a middle position in Europe as regards to educational differences; interestingly, however, the difference in vegetable consumption between those with a high and low educational level in the Netherlands is substantially larger (11.4 percentage points) than for fruit consumption (5.8 percentage points); see also Health-related behaviour and the education gap. The overarching picture is that, across the whole of Europe, eating healthily on a daily basis is more common among higher than lower-educated people. However, the differences between individual countries are considerable. To what extent price, availability or cultural and knowledge disparities play a role here requires further research.

Physical activity
Engaging in sufficient physical activity is relatively evenly divided across educational groups, especially in Northern European countries. The Netherlands is no exception, with a small though not negligible difference of 8.1 percentage points in physical activity between people with a high and low educational level. The differences are substantially greater in Eastern European countries in particular (with the exception of Lithuania), mainly because of a lack of physical activity by those with the lowest educational level in those countries. Europeans with a higher educational level in all countries engage in physical activity to roughly the same degree (between 80% and 90%). Portugal forms an exception here, with reported physical activity being generally relatively low.

Are there differences between countries which would enable us to understand the education gap better?

A logical follow-up question is whether the education gap in health-related behaviour in the various European countries is also associated with core characteristics of those countries. Figure 4.2 illustrates the relationship between a country’s economic development (expressed as GDP) and the six expressions of health-related behaviour that are the focus of this study.

Smoking and alcohol consumption
We can see from the figure that the education gap in smoking in the various countries shows virtually no increase with rising national wealth. This contrasts with the relationship for alcohol consumption, where the educational differences in alcohol consumption do increase with rising economic prosperity (expressed as GDP). It is noteworthy that people with a higher educational level more often consume alcohol, leading to the suspicion that a higher general level of prosperity in a country is mainly associated with increased alcohol consumption by those with higher education. Although it is an unhealthy lifestyle habit, alcohol consumption may also be more widely accepted in wealthier countries; see also Education as a dividing line. It is also possible that people with a high educational level living in more affluent countries more often seek to set themselves apart from their lower-educated compatriots through their cultural lifestyle, for example by drinking good wines or exclusive spirits.

BMI, fruit and vegetable consumption and physical activity
When examining national differences in BMI, by contrast, we find a negative relationship between national wealth and the education gap: the greater the prosperity in a country, the smaller the differences in BMI between those with high and low education. We also find that greater national wealth (GDP) is associated with a shrinking of the education gap as regards eating fruit and vegetables and engaging in physical activity, all regarded as healthy lifestyle expressions. A healthy diet and physical activity evidently become acceptable, accessible and attainable for more people as national wealth increases. As with smoking, however, we note that the association between national wealth and the education gap in BMI, consuming fruit and vegetables and engaging in sufficient physical activity is negligible, unlike the relationship found for alcohol consumption.