Abstract
Education has a large and increasing impact on health in America. This paper examines one reason why. Education gives individuals the ability to override the default American lifestyle. The default lifestyle has three elements: displacing human energy with mechanical energy, displacing household food production with industrial food production, and displacing health maintenance with medical dependency. Too little physical activity and too much food produce imperceptibly accumulating pathologies. The medical industry looks for products and services that promise to soften the consequences but do not eliminate the underlying pathologies. This “secondary prevention” creates pharmacologic accumulation: prolonging the use of medications, layering them, and accruing their side effects and interactions. Staying healthy depends on recognizing the risks of the default lifestyle. Overriding it requires insight, knowledge, critical analysis, long-range strategic thinking, personal agency, and self-direction. Education develops that ability directly and indirectly, by way of creative work and a sense of controlling one’s own life.
Keywords
Education and Health: Why?
Education is the key to good health. The well educated experience better health than others on all indicators (Lauderdale 2001; Mirowsky and Ross 2003; Reynolds and Ross 1998; Ross and Mirowsky 1999, 2010a, b; Ross and Wu 1995, 1996). The question is why. Although there are many explanations, here we focus on one—education helps people override the default American lifestyle (Mirowsky 2011; Mirowsky and Ross 2005b, 2010).
The Default American Lifestyle
The default American lifestyle has three elements: displacing human energy with mechanical energy, displacing household food production with industrial food production, and displacing health maintenance with medical dependency.
A default is an option assigned automatically by an operating system that remains in effect unless canceled or overridden by the operator. The automatic routines of twenty-first-century affluent society are set by the socioeconomic system and physical infrastructure. They developed over centuries with the progressive increase in per capita productivity and wealth. These nearly eliminated the threats to health and survival common in 1900, increasing life expectancy but leaving as residue the diseases of affluence.
Being “healthy” means being vigorous, vital, and fit. The body’s cardiovascular, respiratory, musculoskeletal, metabolic, endocrine, immune, and neurological systems work well. As a result, the individual feels healthy, functions well, and recovers naturally from infections, injuries, and cellular errors.
The default American lifestyle is unhealthy (Mirowsky 2011, 2014; Mirowsky and Ross 2010). Gas engines, electric motors, and electronic communication make travel, work, play, and commerce increasingly sedentary. The locales of daily activity are separated by distances and obstacles that are forbidding and dangerous to anyone not in a motorized vehicle. The industrial production of food products provides an excess of cheap calories always ready at hand. The food is engineered for production, transportation, marketing, and convenience rather than for nutrition. So, people eat lots of packaged and prepared foods, drive from place to place, and sit while working. Their physiological systems, evolved for physical effort in contexts of scarcity, drift further and further from balance. Their muscles become atrophied, their joints inflamed and calcified, their bones brittle and misaligned, their hearts weak and arteries clogged. They take medicines to control blood pressure, cholesterol, and glucose; to regulate bowel movements, urination, stomach acidity, and reflux; to stifle anxiety, depression, and pain. This is the unhealthy lifestyle that remains in effect unless canceled or overridden by the operator.
Given the legacy of too much food and too little physical activity, health depends on the ability to override the standard mode of life. Staying healthy requires insight, knowledge, critical analysis, long-range strategic thinking, personal agency, and self-direction. Education develops that ability directly and indirectly, by way of creative work and a sense of controlling one’s own life (Reynolds and Ross 1998; Mirowsky and Ross 1998, 2007, 2010; Ross and Mirowsky 1999, 2010a, b).
Ironically, the diseases of affluence disproportionately afflict the least advantaged. This has little to do with material deprivation. For the most part, the problem is not that food, transportation, goods, and treatments need to get cheaper and more abundant. The problem is that many individuals cannot see the dangers of the ordinary way of life, or they lack the ability to redesign their lives. Health depends on power: the power of knowledge, the power of critical thinking, and the power to design and direct one’s own life toward better ends. Education puts that power in the hands of individuals.
Education as Key to Health
Educational attainment is a root cause of good health (Ross and Wu 1995, 1996; Miech et al. 2011; Mirowsky and Ross 2003, 2005a). Education’s positive effect on health is pervasive, cumulative, and self-reinforcing. The more years of schooling, the better one’s health, by almost every measure. The well educated enjoy better subjective, self-rated health; better physical functioning; and lower levels of morbidity, impairment, and disability (Mirowsky and Ross 2008; Ross and Mirowsky 1999, 2010a, b; Ross and Wu 1995, 1996). They live longer (Lauderdale 2001; Lleras-Muney 2005; Ross, Masters, and Hummer 2012). They experience better mental health, with lower levels of depression, anxiety, anger, fear, and mistrust (Ross and Van Willigen 1997; Ross and Mirowsky 2003, 2006). The more years of schooling persons have, the higher their feelings of fitness and energy; the fewer their headaches, backaches, and other aches and pains; the less trouble they have sleeping; and the fewer their diagnosed chronic conditions, like arthritis, osteoporosis, diabetes, heart disease, cancer, lung disease, and hypertension (Mirowsky and Ross 2003).
Education is the key to socioeconomic differentials in health. High levels of education lead to full-time employment, high earnings, high household income, and low economic hardship (Mirowsky and Ross 1998, 2003, 2007). Education’s economic benefits protect health, but education itself is the critical factor, for several reasons. First, getting more income improves health less and less as income rises (Mirowsky and Hu 1996; Mirowsky and Ross 2003). The health improvements from increased income occur mostly among household with incomes below the 20th percentile. Above the 65th percentile the health benefits of additional income appear to vanish. In contrast, the net health benefits of additional education remain large at higher levels of attainment (Ross, Masters and Hummer 2012). Second, education moderates the health effects of low income, in large part by reducing the economic hardship associated with it (Mirowsky and Hu 1996; Ross and Mirowsky 2000). Education helps individuals use income more efficiently to meet household needs and maintain personal and family health.
Beyond higher income and less economic hardship, education improves access to full-time employment and to work that is creative, autonomous, and fulfilling (Mirowsky and Ross 2007). When not unemployed, the poorly educated often do jobs that are routine, boring, and oppressive and that do not use their skills, that do not give them opportunities to learn new things or develop, and that are designed and directed by others. Having no job—or having a poorly paid, oppressive one—leaves individuals vulnerable to health risks. Education improves access to the full-time employment and the creative, autonomous, fulfilling work that sustain health.
Together, education and its benefits provide the power to override the default American lifestyle. This is especially true for persons with poorly educated parents (Ross and Mirowsky 2011). The next year of education, the next degree, increases health and well-being the most for those who are least likely to get it. Conversely, getting a college degree nearly eliminates the health risks from having poorly educated parents. Educating the disadvantaged appears especially important for improving health between generations. Without it, the disadvantaged are doubly powerless to override the default.
Education as Human Capital
Because education develops human capital, it provides a unique resource in the path to physical and mental health (Mirowsky and Ross 1998, 2003). In school, people learn to read, write, analyze, communicate, negotiate, solve problems, look things up, figure things out, plan, persevere, trust others, work with colleagues, and develop ideas. These skills and abilities learned in school help people control their own lives. Personal control helps people cope actively and flexibly, avoid problems, and prepare for those that cannot be avoided. Education is a resource itself, and the learned effectiveness it represents helps people generate other resources.
Education has qualities that go beyond those of other social resources because it indicates resourcefulness, or the ability to meet situations effectively. Education is part of the person, rather than external, like neighborhood, job, or income. You can lose your job, but once you have learned to read, write, or think, no one can take that away from you. Those resources increase the ability to control your own life.
Human capital is the productive capacity developed, embodied, and stocked in human beings themselves. An individual who acquires an education can use it to solve a wide range of problems because schooling builds skills and abilities on several levels of generality (Mirowsky and Ross 1998, 2003). On the most general level, education teaches people to learn. It develops broadly useful analytic skills, like math and logic, and, on a more basic level, observing, experimenting, summarizing, synthesizing, and interpreting. In school, one encounters and solves problems that are progressively more difficult, complex, and subtle. The more years of schooling, the greater the cognitive development, characterized by flexible, rational, complex strategies of thinking. Higher education teaches people to think logically and rationally, see many sides of an issue, analyze problems, and solve them.
Education also develops broadly effective habits and attitudes, such as dependability, judgment, motivation, effort, trust, and confidence. In particular, the process of learning creates confidence in the ability to solve problems. Education instills the habit of meeting problems with attention, thought, action, and perseverance. Apart from the value of the skills and abilities learned in school, the process of learning builds the confidence, motivation, and self-assurance needed to attempt to solve problems. Thus, education increases effort, in addition to ability. Effort and ability are the fundamental components of problem solving. For this reason, high levels of education are associated with a sense of personal control.
Beliefs about personal control generally represent realistic perceptions of objective conditions (Mirowsky and Ross 2003). High levels of education increase the sense of personal control—the belief that outcomes are contingent on one’s own choices and actions. People with a high sense of personal control report being effective agents in their own lives. In contrast, the poorly educated may not posses the resources necessary to achieve their goals, which produces a sense of powerlessness, fatalism, and helplessness. Education develops learned effectiveness; its absence produces learned helplessness. Schooling develops capacities that help people override the default American lifestyle.
Elements of the Default American Lifestyle
What exactly is the default American lifestyle that makes education so important to health? To begin with, it is a default: an option taken automatically. It is a way of life that Americans fall into unless they override it—unless they deliberately reject it and actively resist it. For Americans, it takes knowledge, insight, ingenuity, effort, and nerve to live in some other, healthier, way.
As mentioned earlier, the default American lifestyle has three core elements: displacing human energy with mechanical energy, displacing household food production with industrial food production, and displacing health maintenance with medical dependency. Each of these represents a long and relentless trend with little sign of abating. They arose as solutions to problems faced in earlier eras. Every problem has its solutions, but every solution has its problems. Together, the three displacements increasingly degrade the body systems that make people feel healthy, function well, and recover naturally. The first is the oldest and creates the other two.
Displacing Human Energy with Mechanical Energy
This trend goes back to the very origin of human beings, long before machines entered the picture. When hunters and gatherers domesticated fire, they began something that continues to this day: the increasing reliance on “exosomatic” energy, which is energy from outside the human body (Mirowsky 2014; Walker, Walker, and Adam 2003; Wrangham 2009). Before fire, humans extracted calories from food entirely by chewing and digesting. For a primate the size of early humans, cooking food decreases the amount of time spent chewing from 48% of daily activity to 4.7% (Organ et al. 2011). With cooking, human jaws and intestines got smaller, while bodies and brains got larger.
Agriculture again increased reliance on external energy, in the form of draft animals, wind, and falling water (Mirowsky 2014). It also changed the way humans balance calories eaten with calories used, from a daily or weekly dynamic to an annual one. Typically, the food available in an agricultural society lags the demand for labor to produce it. This creates annual body fat cycles as well as technologies for storing, preserving, and distributing food.
Industrialization immensely increased the external energy each human used, now in the form of fossil fuels (Mirowsky 2014). Early machines needed hands and muscles linked to human brains. At first, a shortage of food calories was more common a problem than an excess. By the mid-twentieth century, though, that changed (Dyson 2000; Putnam 2000). Rising agricultural productivity, declining costs of storage and transportation, and rising incomes made food abundant and cheap, while mechanization took the physical activity out of work, transportation, and household chores.
The displacement of human energy continues. New technologies at first seem emancipating. They free individuals from old limitations but gradually eliminate the physical activity they render unnecessary. This is the option ratchet. At first, the physical activity is not necessary, then it is not convenient, and then it is not possible.
Stairs and elevators provide a good example. At first, stairs were the main way between floors in large buildings, prominently located and often elegantly designed. Elevators were only for heavy objects. When safety improvements overcame public reluctance to use elevators, they began to appear tucked behind the stairs, for persons who needed or preferred them (Bernard 2014). Elevators made taller buildings more practical and higher floors more desirable. They gradually became the main way of getting between floors, centrally and prominently located. Stairs got pushed to the far ends of hallways, to serve as fire escapes. They became narrow passages in windowless columns. Doors were marked “For Emergency Use Only,” with alarms sounding when open. Today many buildings have no ground-level entrance to the stairwell. The ground-level door leads out of the building and cannot be entered from outside. In large buildings, elevators made using stairs unnecessary, then inconvenient, then impossible.
Private homes may be next. There is no hard scientific data on trends, but the media provide signs. The following quote comes from a Wall Street Journal article on the increasing fraction of new homes with elevators and on innovative designs that greatly reduce the costs of retrofitting existing homes.
Evelyn Thompson recently installed an elevator in her two-story, single-family home in Port Orange, Fla., after her 84-year-old husband began having problems climbing the stairs after a series of back surgeries. Now she uses it regularly to transport laundry and cleaning supplies and to tote luggage upstairs when visitors arrive. Besides, she adds: “My grandchildren think it’s the next best thing to Disney World.” (Tan 2005)
As the quote illustrates, a product introduced to extend the function of impaired individuals readily displaces physical activity in others.
Americans use ever less somatic energy at work, at home, and getting around (Brownson, Boehmer, and Luke 2005; Church et al. 2005; Mirowsky 2014). Over the past 100 years, the most common occupations shifted from agriculture to manufacturing to service. That meant a shift from the kinds of jobs that require the most physical activity to the kinds that require the least. Meanwhile, all kinds of jobs got less physically demanding. Workers may welcome the labor-saving tools, but efficiency and competition eventually require their use.
At the beginning of the twentieth century, nearly all jobs demanded physical labor, often under grueling and aversive conditions. Now the average job involves physical activity equal to strolling sedately on level ground. Few jobs allow the development of aerobic capacity, muscle strength, bone density, balance, and flexibility.
Technological forces also took physical activity out of transportation and communication. Subur-banization is the clearest (Frank, Martin, and Schmid 2004) indicator (Brownson et al. 2005; Ewing et al. 2003; Frumkin 2002; Mirowsky 2014). Urban scale increased enormously, while urban density decreased. In most places, driving went from optional to essential. Zoning regulations often mandated the physical separation of residences, shops, and workplaces. Now 86% of paid workers drive a private vehicle to work (McKenzie 2014).
As cars increased the geographic scale of daily life, the miles driven running errands, shopping, and socializing also increased. Americans drive an average of 13,600 miles per driver a year. Nonwork driving accounts for 75% of those miles (and 91% of all trips; McKenzie 2014; Santos et al. 2011).
Physical activity at home also decreased substantially over the past century (Brownson et al. 2005; Dyson 2000; Lanningham-Foster, Nysse, and Levine 2003; Mirowsky 2014). Housework hours declined while home activities became increasingly sedentary. In 1900, the average American woman spent 51 hours per week preparing meals and cleaning up after them, cleaning house, and doing laundry. By the beginning of the twenty-first century, average housework hours dropped to around 27, with women doing 17 and men 10.
Most modern housework and childcare activities range in intensity from the energy output of eating and drinking to that of walking on flat, even ground at a normal pace while not carrying anything (Ainsworth et al. 2014). A few household activities are somewhat more intense, such as gardening, house and yard maintenance, and exterior repair. Those have about the same energy intensity as bicycling at a moderate pace on level ground. Shoveling snow is the only strenuous household task remaining common, matching the intensity of jogging or tennis, but not for long. Snow blowers take much of the work out of clearing snow. They are so common that Consumer Reports rates them. Thirteen percent of households already own one, even though more than half of households never need one (Statistica 2013).
As the physical demands of daily life decline, so do the levels of physical abilities. Business and technology provide substitutes for the vanishing abilities, which further reduce the physical demands. As the social norms and built environment adapt, they begin to discourage the activities that create the abilities. With vanishing demands, though, few individuals realize the extent of their own physical limitations.
This brings us to the second element of the default lifestyle.
Displacing Household Food Production with Industrial Food Production
A decline in the cost of food, and a shift from homemade to manufactured and restaurant meals, magnifies the impact of declining physical activity on Americans’ metabolic and vascular systems (Dyson 2000; Kessler 2009; Putnam 2000). In the 1930s, American households spent about 25% of their disposable income on food. By 2010, it was down to 9.4%. Americans spend a smaller fraction of income on food than any other industrialized nation.
A century ago, American households produced some of the food they consumed, and they prepared and served nearly all of it. Most households even baked their own bread. Today, American households spend nearly 60% of their food money away from home. Home-prepared meals are going the way of homegrown food.
Near the end of preindustrial agriculture, sugar appeared as the harbinger of modern industrial food: a commodity extracted from harvested plants, marketed in bulk, shipped thousands of miles, and factored into endless digestible consumer products. Modern packaged and prepared food gets manufactured from raw materials bought and sold in bulk (such as corn) that get processed into “fractions” (components, such as the sugar, starch, protein, and cellulose from corn) that are assembled into products that are readily stored, shipped, and marketed (Pollan 2007).
Industrial food takes the work out of eating. It is, in a way, predigested. Think of chicken as a food. Americans used to raise the chicken, slaughter it, gut it, pluck it, and bone it. Then they bought the chicken already gutted and plucked. Then they bought boneless, skinless chicken breasts. Now they can buy frozen, microwave chicken nuggets extruded from meat slurry, coated with batter, and fully cooked. Food products like chicken nuggets even eliminate most of the chewing and stomach contractions previously needed (Kessler 2009).
Too many Americans used to be hungry, stunted, and emaciated. Now too many are overweight or obese. The dietary excesses contribute to disabling and life-threatening chronic conditions. That brings us to the third element of the default lifestyle.
Displacing Health Maintenance with Medical Dependency
Body mass provides the most visible sign of hidden physiological trends that threaten Americans (Mirowsky 2011, 2014). Body mass index’s (BMI) relationship to invisible biological factors makes it a useful indicator of hidden trends. They include high blood pressure, high ratios of low-density to high-density cholesterol, insulin resistance and poor blood sugar control, oxidative stress, and inflammatory processes that promote atherosclerotic plaques and embolisms. The collection of biomarkers related to BMI is often called the metabolic syndrome.
The end of the twentieth century saw a major trend toward higher age-specific body mass in adulthood. Newer cohorts were entering adulthood with higher median BMI and then gaining weight faster (Mirowsky 2011). The BMI trend suggests that an avalanche of health problems is on its way.
Accumulators
Activity and eating habits, body mass, resting blood pressure, blood triglyceride and cholesterol levels, insulin resistance, and arteriosclerosis are all accumulators (Mirowsky and Ross 2003). By definition, accumulators have two properties: they gather many small effects into one large one, and once present, they tend to stay present. Because biological accumulators sum many small consequences over time, they provide little or no feedback for protective behavioral conditioning.
Body fat serves as a good example. A man who weighs 150 pounds at age 24 will weigh over 300 pounds at age 54 simply by eating 50 calories a day more than he burns. An extra 50 calories a day of food or of activity is not self-evident. It is the number of calories in one Oreo cookie and the number burned in 10 minutes of gardening or brisk walking. The body mass accumulation cannot be seen on a daily, weekly, or even monthly basis. Over a year, the extra five pounds may be visible in a mirror or in the fit of clothing, but the link to behavior will remain invisible. This absence of perceptible feedback means that personally controlling the accumulation requires information, planning, and self-direction.
Bio-accumulators and “Secondary Prevention.”
Much of contemporary medical science searches for bio-accumulators that pose long-run risk of death, impairment, or suffering. That provides the information individuals can use to manage their own bio-accumulations. However, medical science and practice, and the medical industry, lack the ability and incentive to change the way people live and work. Many doctors tell patients the facts and urge them to choose the healthy way. Even so, few people go to the doctor to be told how to live. They go to get treated, typically after a bio-accumulation has become a problem.
The medical industry looks for drugs, devices, or surgeries that promise to manage the accumulators or soften their consequences (Mirowsky 2011; Mirowsky and Ross 2003). The products generally do not eliminate the underlying pathology. For example, cumulative hardening and clogging of the arteries causes a person’s blood pressure to rise with age. Diuretics and ACE inhibitors reduce the blood pressure without changing those accumulations. Diuretics induce the kidneys to remove sodium using water from the blood, which reduces the volume of water in blood vessels, thereby lowering pressure in the vessels (Freis 1983). ACE inhibitors block an enzyme that creates a vessel constrictor responsible for homeostatic up-regulation of pressure (Sweitzer 2003). The vessels remain slack, keeping pressure low. Neither drug reduces the cumulative pathology responsible for the high blood pressure. They simply maintain the individual in a pathological state. Stop taking medication for hypertension, low-density cholesterol, or insulin resistance, and the problem returns to its premedication state—or worse.
Pharm-accumulation
The strategy of “secondary prevention” inadvertently creates pharmacologic accumulation: prolonging the use of medications, layering them, and accruing their side effects and interactions. This especially affects seniors. Forty percent of American seniors take five or more prescription drugs, and 90% take at least one (Gu, Dillon, and Burt 2010).
Clinical experiments represent idealized medical practice. Real practice is less coherent, with a variety of drugs prescribed by different specialists for a variety of disorders at different times, over-the-counter or herbal medication mixed in, and little or no follow-up short of another crisis, which often leads to another specialist who adds new prescriptions but, like the others, bears no responsibility for the full set and does not feel free to remove drugs prescribed by others.
Drugs prescribed for very different reasons can add to an accumulating effect that eventually becomes critical. For example, a variety of drugs have anticholinergic effects that add up across drug and disease classes (Kansas Foundation for Medical Care 2014; Mirowsky 2011; Resource Pharm 2014). They include medications for allergies, depression, diarrhea, spasms, ulcers, atrial fibrillations, irregular heartbeat, edema (due to heart failure, kidney failure, or cirrhosis), hypertension, chest pain, delusions or hallucinations, Parkinson’s, urinary incontinence, vertigo, nausea, and back pain. The anticholinergic effects add up across medications. The complications include bloating, constipation, cramps, loss of appetite, nausea and vomiting, dry mouth and difficulty swallowing, high blood pressure, elevated heart rate, blurred vision, worsening glaucoma, eye pain and light sensitivity, clumsiness, unsteadiness, drowsiness, lethargy, fatigue, confusion, impaired attention, hallucinations, memory loss, delirium, agitation and irritability, slurred speech, and convulsions.
We do not know how many other pharm-accumulation classes exist. A surprisingly large number of medications produce delirium or dementia, particularly in seniors (Mirowsky 2011). Other emerging classes reduce or dilute sodium to dangerous levels, inflame the pancreas, weaken muscles, increase the risk of falls or injuries, or contribute to serotonin toxicity.
Medical interventions do not, and cannot, eliminate the physiological consequences of too much food and too little physical activity. Thirty or forty years from now, it may be common for Americans to arrive at age 65 having taken drugs for attention deficit since childhood, for depression since adolescence, for anxiety and acid reflux since early adulthood, for hypertension and cholesterol since entering middle age, and for insulin resistance since well before the end of middle age. It remains uncertain what effect this medical stew will have, but it will not be health.
Self-direction toward Health
Education, and the sense of control and work creativity it develops, helps individuals to recognize the health risks of the default American lifestyle, evaluate claims about risks and benefits, coalesce healthy behaviors into a coherent lifestyle, and overcome the temptations and obstacles built into the usual way of life.
The differences in health and survival across levels of education are remarkably large (Mirowsky and Ross 2003, 2005a, 2005b; Ross et al. 2012). One way to gauge their size is to compare them to the differences across age groups. In terms of mortality rates, having a college degree rather than only a high school degree is like being eight years younger. Mortality risk doubles with every seven to eight years of age. That means Americans with college degrees have about half the mortality risk of those with only high school degrees.
Subjective health and physical function show even larger benefits. For them, the health benefits of education actually grow across adulthood, accumulating and compounding. Having the college degree becomes like staying 24 years younger.
What all this means for the future health of Americans remains uncertain. Pessimists argue that the obesity epidemic will begin to reduce U.S. life expectancy in the next 30 years. Optimists counter that medical and technological innovation can keep Americans living longer and functioning in the community. Even the optimistic scenario suggests an increasing prevalence of health problems.
In the meantime, social movements urge making stairs more accessible and appealing and communities more walkable and bikeable, and promote small changes in lifestyle that balance calories burned with calories eaten. Public health scientists and officials want to change the default lifestyle to a healthier one. However, as Nestle and Jacobson (2000:18) note, “unintended consequences of our post-industrial society are deeply rooted cultural, social, and economic factors that actively encourage overeating and sedentary behavior and discourage alterations in these patterns.”
Where does America go from here? Let us end with two observations. First, the well-educated, creative, and instrumental Americans are forming overrider enclaves. These are places where the infrastructure and culture help individuals resist the default lifestyle. They are places where it is safe to walk and bicycle; most of what you need or want is nearby; and places to work, shop, and live are interspersed or close (Bina and Kockelman 2006; Center for New Urbanism 2015; Cortright 2009; Tu and Eppli 2001). Some overrider enclaves are entire cities, such as Boulder, Colorado; Portland, Oregon; and San Francisco. Others are like Austin’s new high-density core. Over the last decade or so, this Texas city that never had a high-density urban core made a new one. Here’s the problem: Population growth in Austin’s suburban periphery outstrips growth in its new high-density core (City of Austin 2015). Visitors come to the enclave for the South by Southwest and Austin City Limits festivals. Meanwhile, traffic swirls around that enclave in ever-widening suburban sprawl.
The second observation: increasing levels of education are the best hope we have. Statistical models suggest that rising levels of education kept life expectancy, subjective health, and cognitive and physical function from trending down in the last part of the twentieth century (Alwin, Hofer, and McCammon 2006; Mirowsky and Ross 2008; Ross et al. 2012; Ross and Mirowsky 2011). The models show that at each level of education, mortality rates rose, while health and function declined. However, the average level of education, and the health benefits of additional education, also grew. So far, the net result is longer lives and better health. The models imply that life expectancy, health, and function will decline if education levels stagnate (especially among the disadvantaged). If levels of education rise briskly, then we may together create a new and healthier default American lifestyle.
Footnotes
Authors’ Note
This is the 2014 Leo G. Reeder Award paper, awarded by the Medical Sociology Section of the American Sociological Association. Portions were read at the 2014 RAND Summer Institute Workshop on Aging, Santa Monica, California, and at the 2014 annual meeting of the American Sociological Association, San Francisco.