Académique Documents
Professionnel Documents
Culture Documents
To cite this Article Hammond, Cathie(2002) 'What is it about education that makes us healthy? Exploring the education-
health connection', International Journal of Lifelong Education, 21: 6, 551 — 571
To link to this Article: DOI: 10.1080/0260137022000016767
URL: http://dx.doi.org/10.1080/0260137022000016767
The publisher does not give any warranty express or implied or make any representation that the contents
will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses
should be independently verified with primary sources. The publisher shall not be liable for any loss,
actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly
or indirectly in connection with or arising out of the use of this material.
INT. J. OF LIFELONG EDUCATION, VOL. 21, NO. 6 (NOVEMBER–DECEMBER 2002), 551–571
CATHIE HAMMOND
Wider Benefits of Learning Research Centre, London, UK
Reviews of the evidence conclude that correlations exist between measures of education and
physical health and that a substantial element of this correlation results from the effects of
learning upon health. Closer examination reveals that the correlations between education and
health change across levels of education, and depend upon when during the life course
education is experienced, the type of health condition and the national context. The purpose
of this paper is to investigate these variations with a view to developing fuller understanding of
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
the mechanisms through which learning affects physical and psychological health. Such an
understanding throws light upon the importance of context in relation to the impacts of
education upon health.
Correlations between education and physical health are more consistently found
amongst older adults. There is evidence that education affects the adoption of
health behaviours, and the interaction of the education–health correlation with
age reflects (in part at least) the cumulative risk that many health behaviours
carry. Health behaviours are adopted through processes of awareness raising,
empowerment and socialization. These processes also contribute to the
development of resilience. This is reflected by correlations between education
and lower rates of depression. Learning appears to play an important role in the
rehabilitation of people with mental health problems, and is especially
empowering at times of change in peoples’ lives.
Some studies report negative correlations between education and health. For
example, education and poorly understood conditions appear to be positively
associated. It is suggested that this reflects a bias in attribution of symptoms and
diagnosis, and a more general inequality in access to health services favouring
more educated individuals. This effect of education benefits individuals, but does
not benefit health at the community level. Findings that some neurotic disorders
are positively associated with education, and that education above intermediate
levels is not always associated with positive health outcomes raise issues about the
importance of the educational and national contexts in which people learn. It is
argued that in contexts that foster competition and lack social cohesion,
education can be harmful as well as beneficial to health at collective and
Cathie Hammond is a research officer at the Wider Benefits of Learning Research Centre. Publications include
Learning to be Healthy (London: Institute of Education, 2002) and with John Preston The Wider Benefits of Further
Education: Practitioner Views (London: Institute of Education, 2002).
International Journal of Lifelong Education ISSN 0260-1370 print/ISSN 1464-519X online # 2002 Taylor & Francis Ltd
http://www.tandf.co.uk/journals
DOI: 10.1080/0260137022000016767
552 CATHIE HAMMOND
individual levels. In contrast, education that takes place within a context of co-
operation, integration and challenge is empowering and promotes social cohesion.
Introduction
The government’s Green Paper entitled ‘The Learning Age’ (DfEE 1998, para. 8)
sets out the British government’s vision for learning:
Our vision of the Learning Age is about more than employment. The
development of a culture of learning will help to build a united society,
assist in the creation of personal independence, and encourage our
creativity and innovation.
(1995)
Sweden Wamala et al. (1999)
Finland Valkonen (1993), Benzeval et al. (1995),
Sihvonen et al. (1998)
Norway Sihvonen et al. (1998)
that may throw light upon them is how the correlations between measures of
education and health vary in different contexts. For example, how do the
magnitudes of correlations change depending upon attributes of the learner, such
as their previous educational and health status, their socio-economic status (SES),
age, sex and ethnic background? Are correlations between learning and health
always positive? What are the patterns of correlations for different types of
learning experience? How do they vary with the social and political contexts in
which learning takes place? And what are the different correlations between
learning and different health conditions, including psychiatric conditions?
This paper reviews some of the studies that indicate how education–health
correlations change with some of these variables and discusses the implications.
The next section presents evidence indicating how correlations between
education and health vary. There follows discussion of the ways in which these
variations reflect and contribute to understandings of the processes through
which education affects health, and the importance of context upon the impacts
of education. The final section presents conclusions and discusses policy
implications.
Many of the studies that report evidence for a correlation between (more) education
and (better) physical health use national morbidity and mortality rates as measures
554 CATHIE HAMMOND
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
Correlations between education and health at different stages in the life course
A study of a Dutch cohort born in 1940 suggests that improving physical health is
correlated with additional years of education up to an intermediate level of
education only. Additional years of education after this level are not positively
correlated with physical health, happiness, or wealth (Hartog and Oosterbeck
1998). For this cohort, the correlation between learning and health appears to be
non-linear.
556 CATHIE HAMMOND
Veenhoven (1996) reports that whereas in poor nations the correlation between
more education and greater life satisfaction is positive and consistent, in rich
nations correlations between education and life satisfaction appear to be
weaker, or even non-existent. In addition, Clark and Oswald (1994) analysed
nationally representative British data and found a correlation between higher
levels of education and greater unhappiness amongst those who were
unemployed in 1991.
The patterns of correlations described above are by no means a full picture. For
example, how do the correlations between education and health change
depending upon the sex or ethnic background of the learner, their social and
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
political contexts or the style and content of the learning? It is hoped that these
questions will be tackled in other publications. Nevertheless, the different
magnitudes and directions of the correlations between education and health that
have been identified in the studies reviewed above do beg questions such as why
and what are the implications?
This section comprises a discussion in response to these questions. Much of it is
speculative. The intention is not to provide answers but to raise awareness of certain
issues and to provoke debate. The discussions that follow centre upon the role of
health behaviours, the generation and sustaining of resilience, access to health
services and the importance of context in understanding relationships between
education and health.
Health behaviours are behaviours that are thought to have an effect upon health
outcomes. They include smoking, drinking alcohol, consumption of illegal drugs,
exercise, diet, dental hygiene, use of seat belts, use of condoms and adherence to
medical advice. Individuals tend to behave in ways that are in general either
healthy or less healthy—in other words, individuals who smoke are also more
likely to eat a less healthy diet, exercise less often and so on (e.g. Feigelman et al.
1998, Costakis et al. 1999, Kyngas and Lahdenpera 1999, Slater et al. 1999,
Thompson et al. 1999).
It appears that years of education and higher qualifications are associated with
the adoption of health behaviours. This can be explained in a number of ways.
First, background variables such as parental attitudes and family income may
affect both commitment to education and the adoption of health behaviours.
Second, adoption of health behaviours may lead to educational success. Third,
education may influence the adoption of health behaviours. Studies of the health
behaviours of children and adolescents make it clear that for this age group at
least, the relationships between education and lifestyle are complex (e.g.
Provaznikova et al. 1997, Karvonen et al. 1999, Koivusilta et al. 1999, Resnicow et
THE EDUCATION–HEALTH CONNECTION 557
al. 1999), but that education does appear to play a role in determining the adoption
(or not) of health behaviours.
We have seen above that associations between education and physical health appear
to be weaker amongst younger populations than they are amongst older
populations. One explanation is that whereas some health behaviours—such as
not wearing a seat belt or condom—constitute a constant risk to health, other
health behaviours—such as smoking and excessive alcohol consumption—carry a
cumulative risk. This means that although education plays an important role in
the promotion of physical health through health behaviours, these are only
translated into observable physical health outcomes later in life.
Evidence presented in the previous section suggests that the effects of education
upon the health of younger cohorts are primarily psychosocial as opposed to
physiological (Matthews et al. 1999). These psychosocial outcomes affect health
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
Resilience refers to the dimension of individual difference that spans the ways we
deal with adversity and stressful conditions and how they affect us (e.g. Garmezy
558 CATHIE HAMMOND
1971, Anthony 1974, Rutter 1990). The personal and social resources that
contribute to the development of resilience in children have been examined
extensively, and the relevant literature is reviewed by Howard et al. (1999). Many
of the social and psychological resources that are believed to contribute to
resilience have been identified in other studies as outcomes of education. They
include self-esteem, self-efficacy, interpersonal trust, empathy, feelings of
connectedness, supportive relationships and broader outlooks. The relationships
between education and these outcomes are discussed more fully elsewhere
(Hammond 2002), but the evidence is summarized here in table 3.
Some attributes—namely, problem-solving skills and a sense of purpose—
contribute to resilience but have not been identified empirically as outcomes
of education. Perhaps this is because they are difficult to measure. However,
authors argue that problem-solving skills and a sense of purpose are likely to
be outcomes of education. For example, Mirowsky and Ross (1998: 417)
suggest that education ‘instills the habit of meeting problems with attention,
thought, action, and persistence. Thus, education increases effort and ability,
the fundamental components of problem solving (Wheaton 1980)’. Becker and
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
Mulligan (1994) argue that through the study of history, thinking about
adulthood and imagined scenarios, pupils may learn to think in a more
future-oriented manner.
By definition, an individual with more resilience will experience relatively low
levels of chronic stress in response to a given life stressor. There is considerable
evidence that high levels of chronic stress are damaging in the long term to
physical health. Consequently, it appears that one mechanism through which
learning affects physical health is through developing the resilience of learners.
In addition, resilience protects individuals from the onset and progression of
depression. We have seen that there is robust evidence that individuals with more
education are less likely to have depressive symptoms. Analyses of British
longitudinal datasets suggest that this correlation is at least partly explained by
effects of education upon psychological health (Bynner and Egerton 2000,
Feinstein 2001).
Numerous evaluations and reports indicate that people with mental health
problems experience great personal benefits from learning (Wertheimer 1997),
and some primary care practices have introduced referrals to Community
Adult Education as a prescribable option for treatment (e.g. Wheeler 1999,
James 2001).
There is also evidence that learning is particularly beneficial at stages in the
life course that are characterized by change. At these ‘turning points’, an
individual’s resilience may be of critical importance. For example, Antikainen
(1998) used qualitative biographical techniques to investigate the meaning of
learning experienced by a group of adults in Finland and found that
learning was particularly significant in terms of empowerment for individuals
during times of change, e.g. surviving widowhood, and migration from the
countryside to the city. In addition, Bynner and Egerton’s findings that the
effects of Higher Education upon physical health and malaise are
particularly strong amongst mature students (2000) may reflect the fact that
for many mature students participation in higher education represents a
greater life change than it does for the average 19-year-old who has just left
school.
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
Table 3. Details of studies that demonstrate that learning leads to the development of a range of psychosocial resources
Outcome of learning Type of learning provision Details of learners Country Approach used Reference
A new sense of self- Higher education Mature women England Individual depth Cox and Pascall
evaluation and interviews (1994)
individuality
Increased self-esteem ‘New beginnings’ Adults England Interviews and Hull (1998)
courses questionnaires
Coherence Access courses and Adults England Qualitative West (1995)
higher education
Confidence, ability All types Adults aged between England and Survey plus depth Dench and Regan
THE EDUCATION–HEALTH CONNECTION
continued
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
560
Table 3. continued
Outcome of learning Type of learning provision Details of learners Country Approach used Reference
Empowerment All forms of planned People living in rural and Finland Qualitative Antikainen (1998)
learning urban areas and at biographical
different stages in their lives methods
Social capital Various Various Several Review Glaeser (1999)
Empathy building Mainstream Secondary school students US Analysis of Angell (1983)
and a sense of ‘intermediate’ minutes of
community level meetings
Various People with mental health Great Britain Review Wertheimer (1997)
difficulties
Participation in a People with mental health Great Britain Evaluation of a McGivney (1997)
variety of educational difficulties programme
provision
Community-based High school students US Observation and Ennis et al. (1999)
physical education interviews
programme entitled
‘Sport for Peace’
Connectedness and Attendance at a Older learners Britain Qualitative Jarvis and Walker
a broader outlook summer university (1997)
Participation in a People with mental Britain Evaluation of a McGivney (1997)
variety of educational health difficulties programme
provision
Years of formal Various Various Review Emler and Frazer
education and level (1999)
of attainment
Lower rates of Years of formal Various European Analysis of data Wagner and Zick
ethnic prejudice education countries from Eurobarometer (1995)
using subtle and qualitative
measures
Inter-personal trust Higher education Adults born in 1958 Britain Secondary analysis Bynner and Egerton
(2000)
continued
CATHIE HAMMOND
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
Table 3. continued
Outcome of learning Type of learning provision Details of learners Country Approach used Reference
Supportive Years of schooling, Nationally representative US Secondary analysis Ross and Mirowsky
relationships college degree, sample of adults (1999)
academic quality of
the school
THE EDUCATION–HEALTH CONNECTION
The observed class gradient in prevalence rates of CFS/ME and allergies may arise
because the conditions are difficult to diagnose. The diagnosis (and treatment) of
these conditions differs from the diagnosis of other conditions in that it relies less
upon observable symptoms and more upon how the patient presents their
experience of the condition to the medical practitioner and how the medical
practitioner interprets the information that is provided by the patient.
Consequently, the patient’s understanding of their symptoms, their ability to
describe these symptoms, their confidence in dealing with the medical
practitioner, and the medical practitioner’s respect for the patient play
particularly crucial roles in the diagnosis of these conditions. Each of these
factors is likely to be affected by the patient’s level of education.
Studies of the epidemiology of CFS/ME that suggest a class gradient in
prevalence rates rely upon samples drawn from hospital clinics (Wessely et al.
1998), in which more educated individuals are over-represented. In contrast,
community-based studies investigating the epidemiology of CFS/ME present a
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
different picture, the class gradient being entirely absent (Lawrie and Pelosi
1975, Buchwald et al. 1995, Shefer et al. 1997). Presumably, many individuals
with CFS/ME are receiving inaccurate diagnoses or not receiving any
diagnosis at all. Indeed, there are numerous reports from individuals later
diagnosed to have CFS/ME who were initially given inaccurate diagnoses of
depressive conditions (e.g. ME Association 1998, 1999). Since those with more
education appear to be more readily referred to hospital clinics, as indicated
by the class gradient in clinic-based epidemiological studies, those who are not
referred because they receive inaccurate diagnoses will include a relatively high
proportion of people of lower socio-economic status. A proportion of these
individuals will receive a diagnosis of depression, which may partly account for
the correlation between lower levels of education and higher rates of medically
diagnosed depression.
These correlations between level of education and poorly understood conditions
highlight two important issues. The first is that they are examples of a more general
inequality—that availability of and access to medical care tends to be lower amongst
populations that are more socio-economically deprived. The inequality is
compounded by the fact that these same (socially and economically deprived)
populations are characterized by relatively poor health (e.g. Hart 1971, Saul and
Payne 1997). Studies in Scotland suggest that patients who are socio-
economically deprived are thought to be particularly likely to develop coronary
heart disease and are also less likely to be investigated and treated than their
more socio-economically advantaged counterparts (MacLeod et al. 1999, Pell et al.
2000). 3 The ironic paradox that those most in need of medical support are least
likely to receive it has been termed the ‘inverse care law’ (Hart 1971).
The second and related issue that is highlighted by the relationships between
education, illness attribution and diagnostic bias is that education may be good
for the individual, but it reinforces inequalities within communities. If
education enables an individual to obtain services and treatments, then this
helps them, and probably their family and close friends as well. However, it
may be at the expense of somebody whose need is greater, but whose
education is less adequate.
THE EDUCATION–HEALTH CONNECTION 563
Some studies suggest that more education is not associated with better health at the
level of the individual. Higher levels of education appear to be associated with the
onset and progression of eating disorders (Toro et al. 1995, Westermeyer and
Specker 1999), and Benham and Benham (1982) report a correlation between
educational level and neurotic disorders. In addition, findings that years of
schooling correlate with health and happiness up to an intermediate level of
education only (Hartog and Oosterbeck 1998, Feinstein 2001) raise questions
about associations between education and health at higher levels of education.
These findings do not reconcile easily with preceding discussions pertaining to
the roles of education in the adoption of healthy behaviours, development of
psychological and social resources central to resilience, and access to appropriate
health care. Neither do they reconcile with the well-established relationships
between educational success and higher socio-economic status (e.g. Joseph
Rowntree Foundation 1995, Asplund and Pereira 1999), which is known to
correlate positively with health outcomes (Black et al. 1982, Marmot et al. 1991,
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
Acheson 1998). The explanation for these apparent contradictions may lie in the
effects that contexts have upon impacts of education upon health.
The context of education refers to the whole society, the labour market and work
contexts, educational institutions, families and the individual. Of course, the effects
of each context upon relationships between education and health outcomes will
operate together. But for conceptual simplicity, the effects of each context are
discussed separately.
It is well established that more education increases the chances that individuals
enter white-collar occupations including occupations in the professional
managerial employee strata (e.g. Esping-Anderson 1993, Joseph Rowntree
Foundation 1995). So how does entry into a white-collar professional managerial
occupation affect health outcomes?
564 CATHIE HAMMOND
associated with high levels of job satisfaction are also associated with high levels
of stress (Rose 2000). Occupations associated with low levels of stress include
craft skill groups, such as electricians, carpenters and plumbers, and other blue-
collar workers. 5
Occupational stress may partly account for findings of a study in which level of
education and level of earnings correlated positively with rates of neurotic
disorder (Benham and Benham 1982). The authors report that neither education
nor earnings appeared to provide protection against the onset and progression of
neurotic disorders. The data used for the study relates to a 43-year-old cohort
born in St Louis (USA) in the 1910s and 1920s, and identifies neurotic disorders
if individuals had received a diagnosis of a neurotic disorder since the age of 18.
One hypothesis that would explain these findings—and it is the hypothesis of
interest here—is that educational success increases the chances of obtaining high
earnings, and that the type of employment that is associated with high earnings
contributes to the onset and progression of neurotic disorders. Another
hypothesis, referred to as a selection hypothesis, is that predisposition towards
neurosis also predisposed individuals to success in both education and earnings.
Unfortunately, the analyses do not enable one to distinguish between these two
explanations.
Success in education in a competitive labour market will be good for the health of
the individual so long as it does not lead to occupations and lifestyles that are overly
stress-inducing. However, it is not necessarily good for the community because it
does not change it. It just means that this individual, as opposed to another
individual, obtained the high status, fulfilling, challenging, and possibly highly
stressful job.
The experience of academic stress results from a combination of sources, which are
themselves interrelated: the educational institution, the family and the individual,
all of which will be affected by society. Parents and teachers often impose on
THE EDUCATION–HEALTH CONNECTION 565
children stringent academic demands that are hard to fulfil, and fail to recognize
achievements and efforts that they consider to be less than the child’s ‘best’.
Failure to meet targets may result in peer devaluation. To add further to the
stress, some students place high standards upon themselves.
Bandura (1997: 235–236) suggests that students who have low self-efficacy (that
is, who feel that they have little control over the things that are important to them)
are especially vulnerable to academic stress:
Rather than concentrate on how to master the knowledge and cognitive skills
being taught, they [the students] magnify the formidableness of the tasks and
their personal inadequacies, ruminate about their past failures, worry about
the calamitous consequence of failing, imagine perturbing scenarios of
things to come, and otherwise think themselves into emotional distress and
faulty performances (Sarason 1975, Wine 1982).
Bandura quotes a number of studies which show that it is not academic failure that
causes academic stress, but rather a low sense of personal and academic efficacy
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
Notes
eral practitioner diagnoses that might have explained differential uptakes of cardiovascular services.
4. The Whitehall study of British civil servants began in 1967.
5. Levels of experienced stress are measured using self-report and this measure is validated against other
more objective measures such as blood pressure, digestion, rates of acute episodes of anxiety and depression,
and migraine.
Acknowledgements
I would like to thank John Bynner for his encouragement and advice. The research
described here was undertaken during the initial phase of the work of the Centre for
Research on the Wider Benefits of Learning and was funded by the Department for
Education and Skills. The views expressed in this work are those of the author and do
not necessarily reflect the views of the Department for Education and Skills. All errors
and omissions remain those of the author.
References
A CHESON , D. (1998) Independent Inquiry into Inequalities in Health (London: The Stationery Office).
A NDREWS , J. A. and L EWINSOHN P. M. (1992) Suicidal attempts among older adolescents – prevalence and
concurrence with psychiatric disorders. Journal of the American Academy of Child and Adolescent Psychiatry,
31, 655–662.
A NGELL , A. V. (1998) Practicing democracy at school: a qualitative analysis of an elementary class council.
Theory and Research in Social Education, 26, 149–172.
A NTHONY , E. J., (1974) The syndrome of the psychologically invulnerable child. In E. J. Anthony and C.
Koupernik (eds), The Child in his Family: children at psychiatric risk, International Yearbook, Vol. 3
(New York: Wiley).
A NTIKAINEN , A. (1998) Between structure and subjectivity: life-histories and lifelong learning. International
Review of Education, 44, 215–234.
A RNARSON, E. O., G UDMUNDSDOTTIR , A. and BOYLE, G. J. (1998), Six-month prevalence of phobic symptoms
in Iceland: an epidemiological postal survey. Journal of Clinical Psychology, 54, 257–265.
A SPLUND, R. and PEREIRA, P. T. (eds) (1999) Returns to Human Capital in Europe: A Literature Review (Helsinki:
Taloustieto Oy).
BANDURA , A. and WALTERS, R. H. (1959) Adolescent Aggression (New York: The Ronald Press Company).
BANDURA , A. and W ALTERS, R. H. (1963) Social Learning and Personality Development (New York: Holt, Rinehart
& Winston, Inc.).
568 CATHIE HAMMOND
BANKS , M., BATES, I., BREAKWELL, G., BYNNER , J., E MLER, N., J AMIESON, L. Careers and Identities (Milton
Keynes: Open University Press).
BATTLE, J. (1978) Relationship between self-esteem and depression. Psychological Reports, 42, 745–746.
BECKER, G. S. and M ULLIGAN, C. B. (1994) On the Endogenous Determination of Time Preference.
Discussion paper no. 94-2, Economics Research Center/National Opinion Research Center,
July, mimeo.
BEEKMAN, A. T. F., B REMMER, M. A., DEEG , D. J. H., VAN BALKOM, A. J. L. M., S MIT, J. H., DE BEURS , E., VAN
DYKE , R. and VAN TILBURG , W. (1998) Anxiety disorder in later life: A report from the longitudinal
aging study Amsterdam. International Journal of Geriatric Psychiatry, 13, 717–726.
BENARD , B. (1995) Fostering Resilience in Children. ERIC/EECE Digest, EDO-PS-95-9.
BENHAM , L. and B ENHAM , A. (1982), Employment, earnings, and psychiatric diagnosis. In V. R. Fuchs (ed.),
Economic Aspects of Health (Chicago: University of Chicago Press), pp. 202–220.
BENZEVAL , M., JUDGE, K. and W HITEHEAD , M. (1995) Introduction. In M. Benzeval, K. Judge and M.
Whitehead (eds), Tackling Inequalities in Health: An agenda for action (London: King’s Fund
Publishing), pp. 1–9.
BLACK, D., M ORRIS, J., S MITH, C., TOWNSEND , P., edited by P. TOWNSEND and N. DAVIDSON (1982) Inequalities
in Health – The Black Report (London: Penguin Books).
BREITNER, J. C. S, WYSE, B. W., ANTHONY, J. C., W ELSHBOHMER, K. A., S TEFFENS, D. C., N ORTON, M. C.,
TSCHANZ , J. T., PLASSMAN, B. L., M EYER , M. R., S KOOG, I. and K HACHATURIAN , A. (1999) APOE-
epsilon 4 count predicts age when prevalence of AD increases, then declines – The Cache
County Study. Neurology, 53, 321–331.
BUCHWALD, D., UM ALI, P., UMALI, J., K ITH, P., PEARLMAN, T. and K OMAROFF, A. (1995) Chronic fatigue and
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
the chronic fatigue syndrome: prevalence in a Pacific Northwest Health Care System. Annals of
Internal Medicine, 123, 81–88.
BURNETTE, B. and MUI, A. C., (1994), Determinants of self-reported depressive symptoms by frail elderly
persons living alone. Journal of Gerontological Social Work, 22, 3–19.
BYNNER , J. and A SHFORD, S. (1994) Politics and participation: some antecedents of young people’s political
activity and disaffection. European Journal of Social Psychology, 24, 223–226.
BYNNER , J. and E GERTON, M. (2000) The Social Benefits of Higher Education. Internal report produced for
HEFCE.
C AIRNEY , J. and ARNOLD, R. (1998) Socioeconomic position, lifestyle and health among Canadians aged 18
to 64: a multi-condition approach. Canadian Journal of Public Health, 89, 208–212.
C AMPBELLl, C. (2000) Social capital and health: contextualizing health promotion within local community
networks. In S. Baron, J. Field and T. Schuller (eds), Social Capital: Critical Perspectives (Oxford:
Oxford University Press), pp.182–196.
C ARLTON, S. and S OULSBY , J. (1999) Learning to Grow Older and Bolder (Leicester: NIACE).
C LARK, A. E. and OSWALD, A. J. (1994) Unhappiness and unemployment. Economic Journal, 104, 648–649.
C ONSORTIUM ON THE S CHOOL-BASED P ROMOTION OF S OCIAL C OMPETENCE (1994) The school-based promotion of
social competence: theory, research, practice and policy. In R. Haggerty, L. R. Sherrod, N.
Garmezy and M. Rutter (eds), Stress, Risk and Resilience in Children and Adolescents: processes,
mechanisms and interventions (New York: Cambridge University Press), pp. 268–316.
C OX, R. and P ASCALL, G. (1994) Individualism, self-evaluation and self-fulfilment in the experience of
mature women students. International Journal of Lifelong Education, 13, 159–173.
DENCH , S. and R EGAN, J. (1998) Learning in Later Life: Motivation and Impact. Report issued by the
Institute for Employment Studies.
DESAI, S. (1987) The estimation of the health-production function for low-income working men. Medical
Care, 25, 604–615.
DfEE (1998) The Learning Age: a renaissance for a new Britain (London: The Stationery Office).
E MLER, N. and FRASER , E. (1999) Politics, the education effect. Oxford Review of Education, 25, 251–273.
E NNIS , C. D., S OLMON, M. A., S ATINA , B., L OFTUS, S. J., M ENSCH , J. and MC C AULEY , M. T. (1999) Creating a
sense of family in urban schools using the ‘Sport for Peace’ curriculum. Research Quarterly for Exercise
and Sport, 70, 273–285.
E SPING -ANDERSON , G. (ed.) (1993) Changing Classes: Stratification and Mobility in Post-Industrial Societies (London:
Sage).
FEINSTEIN , L. (2001) ‘Review of Quantified Evidence on the Wider Benefits of Learning and Related
Potential Costs and Savings: Crime and Health’. Report to the Treasury/DfES.
FERRERO, V., M ARCO, G., BENITEZ, H., DERIVERA , G. and REVUELA , J. L. (1994) Risk-factors in suicide
attempts. Folia Neuropsiquiatrica, 29, 35–54.
FRIEBERG , H. J., S TEIN, T. A. and H UANG , S. L. (1995) The effects of classroom management intervention on
student achievement in inner city elementary schools. Educational Research and Evaluation, 1, 33–66.
G ARMEZY, N. (1985) Stress resistant children: the search for protective factors. In J. E. Stevenson (ed.),
Recent Research in Developmental Psychology (Oxford: Pergamon Press), pp. 213–233.
G ILLESKIE, D. B. and H ARRISON, A. L. (1998) The effect of endogenous health inputs on the relationship
between health and education. Economics of Education Review, 17, 279–296.
THE EDUCATION–HEALTH CONNECTION 569
G LAESER , E. L. (1999) The Formation of Social Capital. Paper delivered at OECD/Canada Statistics
Conference entitled ‘Human and Social Capital’, Quebec, March.
G ROSSMAN, M. (1975) The Correlation between Health and Schooling. In N.E. Terleckyj (ed.), Household
Production and Consumption: Studies in Income and Wealth. Vol. 40, Conference on Research in
Income and Wealth (New York: Columbia University Press for the National Bureau of
Economic Research), pp. 147–211.
G ROSSMAN, M. and K AESTNER , R. (1997) Effects of Education on Health. In J. R. Behrman and N. Stacey
(eds), The Social Benefits of Education (Ann Arbor: The University of Michigan Press), pp. 69–123.
H ARE, E. (1983) Was insanity on the increase? The fifty-sixth Maudsley Lecture. British Journal of Psychiatry,
142, 439–455.
H ARTOG, J. and OOSTERBEEK , H. (1998) Health, wealth and happiness: why pursue a higher education?
Economics of Education Review, 17, 245–256.
H EINRICH , J., P OPESCU, M. A., WIST, M., G OLDSTEIN , I. F. and W INCHMANN , H. E. (1998) Atopy in children
and parental social class. American Journal of Public Health, 88, 1319–1324.
H ILL, P., M URRAY, R. and THORLEY, A. (1986) Essentials of Postgraduate Psychiatry, 2nd edn (London: Grune &
Stratton).
H OWARD , S., DRYDEN, J. and J OHNSON , B. (1999) Childhood resilience: review and critique of literature.
Oxford Review of Education, 25, 307–323.
H ULL, B. (1998) Education for Psychological Health. Adult Learning, September, 15–17.
J AMES, K. (2001) ‘Prescriptions for Learning’ Evaluation Report (Leicester: NIACE).
J ARVIS , P. and W ALKER, J. (1997) When the process becomes the product: summer universities for seniors.
Education and Ageing, 12, 60–68.
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
J OSEPH ROWNTREE F OUNDATION (1995) Inquiry into Income and Wealth (York: Joseph Rowntree Foundation).
K ENKEL , D. S. (1991) Health behavior, health knowledge, and schooling. Journal of Political Economy, 99,
287–305.
K OBERG , C. S., B OSS, R. W. and GOODMAN, E. (1998) Factors and outcomes associated with mentoring
among health-care professionals. Journal of Vocational Behavior, 53, 58–72.
K OCKEN , P. L. and VOORHAM, A. J. J. (1998) Effects of a peer-led senior health education program. Patient
Education and Counseling, 34, 15–23.
M ACKENBACH , J. P. (1993) Inequalities in health in the Netherlands according to age, gender, marital status,
level of education, degree of organisation, and region. European Journal of Public Health, 3, 112–118.
M ACKENBACH , J. P., L OOMAN, C. W. N. and VANDERMEER , J. B. W. (1996) Differences in the misreporting of
chronic conditions, by level of education: the effect on inequalities in prevalence rates. American
Journal of Public Health, 86, 706–711.
M ARMOT, M.G., S MITH, G.D., S TANSFELD , S., P ATEL, C., N ORTH, F., HEAD , J., WHITE , I., B RUNNER , E. and
FEENEY , A. (1991) Health inequalities among British civil servants: the Whitehall II study. Lancet,
337, 1387–1393.
M ATTHEWS, S., M ANOR, O. and P OWER, C. (1999) Social inequalities: are there gender differences? Social
Science and Medicine, 48, 49–60.
M CG IVNEY , V. (1997) Evaluation of the Gloucester Primary Health Care Project, GLOSCAT.
Unpublished report.
M CM AHON, W. (1999) Education and Development—Measuring the Social Benefits (Oxford: Oxford University
Press).
ME ASSOCIATION, (1998,1999 ) Perspectives: The Journal of the ME Association. 69–72.
M IROWSKY, J. and ROSS, C. E. (1998) Education, personal control, lifestyle and health—A human capital
hypothesis. Research on Ageing, 20, 415–449.
M ITCHELL, R. A., L EGGE , V. and S INCLAIRLEGGE , G. (1997) Membership of the University of the Third Age
(U3A) and perceived well-being. Disability and Rehabilitation, 19, 244–248.
M ONTGOMERY, S. M. and S CHOON, I. (1997) Health and Health Behaviour. In J. Bynner, E. Ferri and P.
Shepherd (eds), Getting On, Getting By, Getting Nowhere (Aldershot: Dartmouth), pp. 77–97.
M OOKHERJEE, H.N., (1998), Perception of happiness among elderly persons in metropolitan USA. Perceptual
and Motor Skills, 87, 787–793.
N ATIONAL H EALTH S TRATEGY (1992), Enough to make you sick: How Income and Environment Affect Health. National
Health Strategy Research Paper no. 1, Department of Health, Housing and Community Services,
Canberra, Australia.
N OREAU , L., DJON, S. A., VACHON, J., G ERVAIS, M. and L ARAMEE, M. T., (1999) Productivity outcomes of
individuals with spinal cord injury. Spinal Cord, 37, 730–736.
OOGDEN, J. (1997), Health Psychology: A Textbook (Buckingham: Open University Press).
P APPAS, G. S., QUEEN, S., H ADDEN , W. and F ISHER, G. (1993) The increasing disparity in mortality between
socioeconomic groups in the United States, 1960 and 1986. New England Journal of Medicine, 329,
103–108.
P ARRY, G., M OYSER , G. and DAY , N. (1992) Political Participation and Democracy in Britain (Cambridge:
Cambridge University Press).
570 CATHIE HAMMOND
P IPERNO , A. and DI ORIO, F. (1990) Social differences in health and utilisation of health services in Italy. In
R. Illsley and P. G. Svensson (eds), Social Science and Medicine: Health Inequalities in Europe, Special
Issue, 31, 223–420.
P UTNAM, R. D. (2000) Bowling Alone: the collapse and revival of American community (New York: Simon &
Schuster).
RINI, C. K. DUNKELSCHETTER , C., WADHWA , P. D. and S ANDMAN, C. A. (1999) Psychological adaptation and
birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy.
Health Psychology, 18, 333–345.
RODRIGUEZ -G ARCIA, T. and G OLDMAN, P. (1994) The Health Development Link (Washington DC: Pan American
Health Organization/WHO).
ROSE, M. J. (2000) Future tense? Are the growing occupations more stressed-out and depressive? Working
Paper 5: ESRC Future of Work Programme (Swindon). ESRC, ISSN 1469-1531 .
ROSE, N. (ed.) (1994) Essential Psychiatry (Oxford: Blackwell Scientific).
ROSS, C. E. and M IROWSKY, J. (1999) Refining the association between education and health: the effects of
quantity, credential, and selectivity. Demography, 36, 445–460.
RUTTER, M. (1985) Resilience in the face of adversity: protective factors and resistance to psychiatric
disorder. British Journal of Psychiatry, 147, 598–611.
RUTTER, M. (1990) Psychosocial resilience and protective mechanisms. In J. Rolf, A. Masten, D. Cicchetti,
K. Neuchterlein and S. Weintraub (eds), Risk and Protective Factors in the Development of Psychopathology
(New York: Cambridge University Press), pp. 181–214.
S EEMAN , M. and L EWIS , S. (1995) Powerlessness, health and mortality: a longitudinal study of older men and
mature women. Social Science and Medicine, 41, 517–525.
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010
S EEMAN , M. and S EEMAN, T. E. (1983) Health behavior and personal autonomy: a longitudinal study of
older men and mature women. Social Science and Medicine, 41, 517–525.
S EEMAN , M., S EEMAN, A. Z. and BUDROS, A. (1988) Powerlessness, work and community: a longitudinal
study of alienation and alcohol use. Journal of Health and Social Behavior, 29, 185–198.
S HEFER , A., DOBBINS , J., F UKUDA , K., S TEELE, L., K OO, D., N ISENBAUM , R. and RUTHERFORD, G. W. (1997)
Fatiguing illness among employees in three large state office buildings, California, 1993: was
there an outbreak? Journal of Psychiatric Research, 31, 31–43.
S IHVONEN , A. P., K UNST , A. E., L AHELMA, E., VALKONEN, T. and MACKENBACH , J. P. (1998) Socioeconomic
inequalities in health expectancy in Finland and Norway in the late 1980s. Social Science and
Medicine, 47, 303–315.
TEISL , M. F., L EW , A. S. and DERBY, B. M. (1999) The effects of education and information source on
consumer awareness of diet-disease relationships. Journal of Public Policy and Marketing, 18, 197–207.
TORO, K., N ICOLAU, R., C ERVERA, M., C ASTRO, J., BLECUA, M. J., Z ARAGOZA, M. and TORO, A. (1995) A
clinical and phenomenological study of 185 Spanish adolescents with anorexia-nervosa. European
Child and Adolescent Psychiatry, 4, 165–174.
TURNER , J. B. (1995) Economic context and the effects of unemployment. Journal of Health and Social
Behaviour, 36, 213–229.
TURNER , H. A. and TURNER , R. J. (1999) Gender, social status, and emotional reliance. Journal of Health and
Social Behavior, 40, 360–373.
VALDINI, A. F., S TEINHARDT , S. I. and JAFFE, A. S. (1987) Demographic correlates of fatigue in a university
family health centre. Family Practitioner, 4, 103–107.
VALKONEN, T. (1993) Problems in the measurement and international comparisons of socioeconomic
differences in mortality. Social Science and Medicine, 36, 409–418.
VEENHOVEN , R. (1996) Developments in satisfaction-research. Social Indicators Research, 37, 1–46.
VEENSTRA, G. (2000) Social capital, SES and health: and individual-level analysis. Social Science and Medicine,
50, 619–629.
VEGA D IENSTMAIER , J. M., M AZZOTTI, G., S TUCCHIPORTOCARRERO, S. and C AMPOS, M. (1999) Prevalence and
risk factors for depression in postpartum women. Actas espanolas de psiquiatria, 27, 299–303.
WAGNER , U. and Z ICK , A. (1995) The relation of formal education to ethnic prejudice: its reliability,
validity and explanation. European Journal of Social Psychology, 25, 41–56.
WAMALA, S. P., M ITTLEMAN, M. A., S CHENCK-GUSTAFSSON , K. and ORTH-GOMER, K. (1999) Potential
explanations for the educational gradient in coronary heart disease: a population-based case-
control study of Swedish women. American Journal of Public Health, 89, 315–321.
WANG , M. C. (1997) Next steps in inner-city education. Focusing on resilience, development and learning
success. Education and Urban Society, 29, 255–276.
WERTHEIMER , A. (1997) Images of Possibility. Creating learning opportunities for adults with mental health difficulties
(Leicester: National Institue of Adult Continuing Education).
WESSELY, S., HOTOPH, M. and S HARPE, M. (1998) Chronic Fatigue and its Syndromes (Oxford: Oxford University
Press).
WEST, L. (1995) Beyond fragments: Adults, motivation and higher education. Studies in the Education of
Adults, 27, 133–156.
WESTERMEYER, J. and S PECKER, S. (1999) Social resources and social function in comorbid eating and
substance disorder: a matched pairs study. American Journal on Addictions, 8, 332–336.
THE EDUCATION–HEALTH CONNECTION 571
WHEATON, B. (1980) The sociogenesis of psychological disorder: an attributional theory. Journal of Health
and Social Behavior, 21, 100–124.
WHEELER , M., S MITH, F. and TRAYHORN, L. (1999) Improving health through referral to adult education.
Report produced by the Kingston and Richmond Health Authority and the Royal Borough of
Kingston-upon-Thames.
WORLD B ANK (1993) World Bank Development Report (New York: World Bank).
Downloaded By: [PERI Pakistan] At: 05:42 31 August 2010