Less Than High School Education in United States

United States

Keeping children and adolescents in school through high school graduation and beyond is a key strategy to advance health equity as educational attainment is a strong predictor of future health outcomes. The connection between education and health is well documented — lower educational attainment among adults is correlated with poorer health, while higher educational attainment is associated with better jobs, higher earnings and fewer chronic conditions. Individuals with lower educational attainment are at greater risk of adverse health outcomes such as worse general health, more chronic conditions, more functional limitations and disability, and premature death.

The high school graduation rate is lower among:

• American Indian/Alaska Native, Black and Hispanic students compared with Asian/Pacific Islander and white students.
• Students who had children at a young age.
• Students with disabilities.
• Students with limited English proficiency.
• Students experiencing homelessness.

According to one study, interventions to increase high school graduation rates should target health-related and socioeconomic barriers to graduation. These include absenteeism, developmental delay due to chronic stress, chronic illness, poverty, hunger, homelessness and teen pregnancy. The expansion of school-based health centers can help address these barriers. 

Several high school completion programs have successfully improved high school graduation rates by targeting high-risk populations. Programs aimed at increasing high school graduation rates — and ultimately health equity — include: 

• Vocational training and alternative schooling.
• Social-emotional skills training.
• College-oriented programming, mentoring and counseling.
• Attendance monitoring and case management.
• Community service opportunities.

Increasing the proportion of students who graduate in four years with a regular diploma is a Healthy People 2030 adolescent health objective.

American Public Health Association. “The Dropout Crisis: A Public Health Problem and the Role of School-Based Health Care.” Washington, D.C.: APHA Center for School, Health and Education, February 2018. https://apha.org/-/media/Files/PDF/SBHC/Dropout_Crisis.ashx.

Hahn, Robert A., John A. Knopf, Sandra Jo Wilson, Benedict I. Truman, Bobby Milstein, Robert L. Johnson, Jonathan E. Fielding, et al. “Programs to Increase High School Completion: A Community Guide Systematic Health Equity Review.” American Journal of Preventive Medicine 48, no. 5 (March 26, 2015): 599–608. https://doi.org/10.1016/j.amepre.2014.12.005.

Hummer, Robert A., and Elaine M. Hernandez. “The Effect of Educational Attainment on Adult Mortality in the United States.” Population Bulletin 68, no. 1 (June 2013): 1–16. https://pubmed.ncbi.nlm.nih.gov/25995521/.

Lansford, Jennifer E., Kenneth A. Dodge, Gregory S. Pettit, and John E. Bates. “A Public Health Perspective on School Dropout and Adult Outcomes: A Prospective Study of Risk and Protective Factors From Age 5 to 27 Years.” Journal of Adolescent Health 58, no. 6 (March 19, 2016): 652–58. https://doi.org/10.1016/j.jadohealth.2016.01.014.

Raghupathi, Viju, and Wullianallur Raghupathi. “The Influence of Education on Health: An Empirical Assessment of OECD Countries for the Period 1995–2015.” Archives of Public Health 78, no. 1 (December 2020): 20. https://doi.org/10.1186/s13690-020-00402-5.

“Why Education Matters to Health: Exploring the Causes.” Issue Brief #2. Education and Health Initiative. Richmond, VA: The VCU Center on Society and Health and Robert Wood Johnson Foundation, April 2014. https://societyhealth.vcu.edu/media/society-health/pdf/test-folder/CSH-EHI-Issue-Brief-2.pdf.

Zajacova, Anna, and Elizabeth M. Lawrence. “The Relationship Between Education and Health: Reducing Disparities Through a Contextual Approach.” Annual Review of Public Health 39 (April 1, 2018): 273–89. https://doi.org/10.1146/annurev-publhealth-031816-044628.