Public Policies in Historical Context and the Association Between Education and US Older Adults’ Health

Policy Points Improving population health while reducing inequality is possible, but it depends on broad institutional investments whose benefits extend across the socioeconomic distribution rather than accruing primarily to the advantaged. The education-health gradient is sensitive to the race between technology and education. Recent advances have disproportionately benefitted college-educated persons, and differential automation risk and unequal access to therapeutics, such as GLP-1 agonists, may widen these gaps further and further entrench this inequalities without policy intervention to improve the health of the whole population. To the extent that technological displacement accelerates job loss and compounds the economic and social precarity already driving the stagnation in life expectancy among less-educated persons, the educational divide in health is poised to widen further unless policies decouple access to health insurance from employment status or otherwise shore up the labor market position of the most vulnerable workers. CONTEXT: In this perspective, we have reviewed the historical evidence on the association between education and health in the United States, arguing that attention to public policies related to both education and technology are fundamentally important in understanding historical changes in the educational divide in life expectancy. METHODS: Our assessment of the literature suggests that the relatively narrow educational gap in life expectancy throughout much of the 20th century until 1970 reflected a rapid expansion of education in the population combined with the deployment of technologies that benefitted the majority of Americans. In the latter part of the 20th century and into the 21st century, however, life expectancy for Americans with less than a college degree stalled, whereas the life spans of college-educated Americans grew at a rapid pace. FINDINGS: We argue that the faster pace of technological change compared to educational changes in the population fueled the rise in life expectancy of college-educated persons, with life expectancy among less-educated persons being increasingly contingent on state policies focused on employment and health opportunities. CONCLUSIONS: The implications of these findings suggest that the educational divide in adult health is likely to grow even greater in the decades ahead with continued rapid technological advances.