Study adds to growing recognition that improving graduation rates can improve public health

A new study finds that dropping out of high school greatly increases the risk of illness and disability in young adulthood. It's another example of why education is one of the greatest social determinants of health and a key leverage point in improving health across the lifespan.

Published earlier this month in the journal BMC Public Health, researchers found that dropping out of high school was associated with later illness and disability even after adjusting for other factors, such as family socioeconomic status, health-related risk behaviors, psychosocial risk factors and school problems. In fact, they found that a "high school completer with the highest predicted tendency to drop out...had a lower risk for medical (disability) benefits than a school dropout with the lowest predicted tendency to dropout." To explore the association, the study authors linked data from more than 6,600 adolescents participating in the Norwegian Young-HUNT1 Survey — one of the largest health studies ever conducted — to data on long-term sickness absence and disability pension among people ages 24 to 29.

Among the results, study authors found that the risk difference for long-term sickness or disability between those who complete high school and those who drop out was 21 percent. And even after adjusting for the accompanying risk factors listed above the risk difference was still 15 percent. Overall, the study noted that those dropping out of high school were more likely to be male, have health problems, smoke, be physically inactive and have experienced bullying and loneliness. Researchers Karin De Ridder, Kristine Pape, Koenraad Cuypers, Roar Johnsen, Turid Lingaas Holmen, Steinar Westin and Johan Hakon Bjorngaard wrote that:

In a life-course approach study, low decision latitude as a young adult was strongly associated with later long-term sickness absence, but the effect disappeared when educational attainment and childhood IQ were included in the analyses. One possibility is that school dropouts face an increased risk in a “no exit” situation and are forced into social circumstances that offer no alternative choices. It might also be that they are less able to adapt successfully when they become ill because they lack qualifications and skills which their peers might develop at school or which are necessary to maintain schooling. For a successful learning process, not only cognitive ability is important.

Describing high school dropout as a "major public health challenge," the authors concluded that addressing their findings will require a multisectoral approach that involves schools and educators, employers and public health practitioners. Indeed, many American researchers have come to the same conclusion. In 2007, public health professor Nicholas Freudenberg and co-author Jessica Ruglis published an article in CDC's Preventing Chronic Disease journal on "Reframing School Dropout as a Public Health Issue" that has since become widely cited in discussions on the topic. In the article, the authors wrote that "if medical researchers were to discover an elixir that could increase life expectancy, reduce the burden of illness, delay the consequences of aging, decrease risky health behavior, and shrink disparities in health, we would celebrate such a remarkable discovery. Robust epidemiological evidence suggests that education is such an elixir."

However, at the time of the CDC article the authors noted that increasing high school graduation rates was rarely singled out as a major public health objective, despite the strong links between education and morbidity and mortality. Fortunately, the movement to recognize the role that educational attainment plays in lifelong health is gaining traction. For example, Healthy People 2020, the country's health objectives for the current decade, calls for increasing the number of students who graduate with a regular diploma four years after starting ninth grade by 10 percent, and the American Public Health Association has an entire center dedicated to positioning school-based health centers as key resources in preventing dropout.

According to the National Center for Education Statistics, the U.S. dropout rate declined from 12 percent in 1990 to 7 percent in 2011, with rates declining among whites, blacks and Hispanics. To download a copy of the BMC Public Health study, click here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.