New State-by-State Report Shows Gaps in Health Strongly Linked to Education Levels

    • May 6, 2009

Across the country and in every state, adults with less education are more likely to be in less than very good health than college graduates, and adults in every state fall far short of the level of good health that should be achievable for all Americans, says a new report released today by the Robert Wood Johnson Foundation Commission to Build a Healthier America. The report is the first to rank states on differences in adults’ health based on their levels of education, and it shows that while people with more education are healthier, in some states these differences are much more dramatic than in others.

In fact, almost half of all adults ages 25 to 74 in the United States report being in less than very good health, and that rate differs depending on level of education. For example, adults who have not graduated from high school are more than two and a half times as likely to be in less than very good health as college graduates, according to the report. Those who have graduated from high school but not gone to college are nearly twice as likely to be in less than very good health as college graduates.

The report, Reaching America’s Health Potential Among Adults: A State-by-State Look at Adult Health, comes a month after the Commission issued recommendations for removing barriers to good health in the United States, and adds to a growing body of research highlighting the extent to which social factors affect health. This report is a companion to one released in 2008 by the Commission—America’s Health Starts With Healthy Children: How Do States Compare?—that examined the fundamental role that family income and education play in children’s health.

A growing body of Commission research provides strong evidence that there’s more to health than health care, and that education, income and other factors outside the medical care system are important determinants of how healthy people are and even how long they will live.

“Access to affordable, high-quality medical care is essential but that alone will not improve the health of all Americans,” says Alice M. Rivlin, co-chair of the Commission. “What this report tells us is that education has a tremendous impact on how long and how well we live. Policy-makers need to focus on schools and education, as well as promoting healthier homes, communities and workplaces, to improve the health of our nation.”

The 20-page report shows that while the gaps between the least and most educated are the most dramatic there can be significant gaps in health even between those with some college education and those who have finished college. These gaps in health by education exist in every state—even states that rank highest when it comes to overall health.

Education and Adult Health

  • In the United States, 45 percent of adults reported being in less than very good health. This rate varies widely across states from a high of 53 percent in Mississippi to a low of 35 percent in Vermont.
  • The health gaps related to education can be seen within states as well. In Mississippi, nearly three-quarters of adults who had not graduated from high school reported being in less than very good health, compared with 37 percent of college graduates.
  • Even in Vermont, which fares best in overall health of adults, 68 percent of adults who had not finished high school reported they were in less than very good health compared with 22 percent of college graduates.

Racial and ethnic minorities were more likely to report being in less than very good health, but differences in health status by education level are still seen within every racial or ethnic group. Nationally, for example, 44 percent of African-American college graduates reported they were in less than very good health compared with 55 percent of those with some college, 62 percent of high school graduates, and 73 percent of those who had not finished high school. The report emphasizes that health is closely linked with both education and racial or ethnic group.

Narrowing Health Gaps

Researchers identified significant health gaps by education within states when comparing the rate of less than very good health in each state overall with the rate seen for the state’s college graduates. California has the biggest gap, ranking last in the country, while Delaware has the smallest gap and ranks first.

  • In California, 48 percent of all adults reported that they were in less than very good health, compared with only 28 percent of college-graduate adults. Thus, the health gap between college graduates in California and adults in the state overall is nearly 20 percent, the biggest difference in the nation.
  • In contrast, 41 percent of all Delaware adults reported they were in less than very good health, compared with 32 percent of college graduates. The health gap between Delaware’s college graduates and adults in the state overall is only 9 percent, the smallest difference in the nation.

“Regardless of where your state falls in these rankings, the news isn’t good,” says Mark McClellan, co-chair of the Commission. “Education is an important marker for an array of opportunities that can lead to better health. One of the most important things we can do for our nation’s health is to improve education quality and educational attainment.”

In Every State, Adults Could Be Healthier

In addition to the state rankings, researchers established a national benchmark for adult health, looking at the best level of health achieved in any state among college-graduate adults who also have healthy behaviors. This benchmark rate—a level of good health that has been observed and is thus achievable—was found in Vermont, where the rate of less than very good health was only 19 percent among college graduates who exercise and do not smoke. Comparing rates in every state against this benchmark reveals that U.S. adults at every education level and in every racial or ethnic group—are not as healthy as they could be.

“What this tells us is that there is room for improvement, not only as a nation but in every state, and that focusing on education is important for reducing these health shortfalls,” says Paula Braveman, M.D., M.P.H., a lead study author. Braveman notes that the findings for adult health mirror those seen in children’s health. Not surprisingly, health behaviors are an important component in adult health, but differences in behaviors explain only part of the differences in health by education, she adds.

Focusing on a key social factor that affects health, the report provides new national and state-level information on how healthy adults in this country are and how healthy they could be. An interactive online tool from the Commission lets viewers see firsthand the links between education and mortality for states and most counties. The Education and Health Calculator lets users examine the current level of education in their own county or state and determine how many deaths might be averted if a larger proportion of the population attended college. 


The Robert Wood Johnson Foundation Commission to Build a Healthier America is a national, independent nonpartisan group of leaders tasked with seeking ways to improve the health of all Americans. Launched in February 2008, the Commission has investigated how factors outside the health care system—such as income, education and environment—shape and affect opportunities to live healthy lives. The Commission, which is co-chaired by former senior Administration officials Mark McClellan and Alice M. Rivlin, both now at the Brookings Institution, issued 10 recommendations to improve America’s health in April 2009.