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Subject: HBNS, Nov. 27, 2002 -- Facts of Life: Education and Health
Disparities
FROM THE HEALTH BEHAVIOR NEWS SERVICE
*************************************
Live and learn, as the saying goes - but maybe it should be the other way
around. "Learn and live" may well be a more appropriate expression, since
research shows a strong link between education levels and overall health.
This month's Facts of Life looks into the ways in which education has been
associated with various health risks and outcomes, including interviews with
two experts on the topic from the University of California, San Francisco
School of Medicine and the nonprofit RAND institution. So check out the ABCs
of this important health disparities topic, and mind your Ps and Qs.
Best wishes,
Kristina Campbell, Editor
Health Behavior News Service
www.hbns.org
Center for the Advancement of Health
2000 Florida Ave., NW, Suite 210
Washington, DC 20009
Phone: 202-387-2829; Fax: 202-387-2857
* * *
FACTS OF LIFE
December 2002
Vol. 7, No. 12
* * *
Life Lessons:
Studying Education's Effect on Health
* * *
CONTENTS
* The Issue
* The Facts
* Interview: Socioeconomic Disparities and Health: Identifying the Ways
Education Plays a Role, with Nancy E. Adler, Ph.D.
* Interview: Education, Technology and Self-Management: Explaining the
SES-Health Gradient, with Dana P. Goldman, Ph.D.
* Heart Smart: The Link Between Education and Cardiovascular Disease
* Definitions and Implications
* Resources
* Bibliography
* * *
THE ISSUE:
Education has been shown to be a powerful and unique predictor of health
outcomes - lower levels of education are associated with poor health and
higher levels of education are associated with better health. Questions
remain, however, about which aspects of education may relate to health, the
pathways or mechanisms through which education would exert an effect on
specific health outcomes, and whether there may be other characteristics or
factors that affect both educational attainment and health outcomes.
* * *
THE FACTS:
* Mortality rates overall and for specific diseases (including heart disease
and cancer) are higher in the United States for individuals with lower
educational or income status. Exceptions to this include death rates for
breast cancer and external causes in women. (1)
* In 1995, the death rate from chronic diseases for men with less than 12
years of education was 2.5 times the rate for more educated men. Women were
slightly more than twice as likely to die if they had less than 12 years of
education. (2)
* The number of people who smoked cigarettes, the leading cause of
preventable disease and death in the United States, declined substantially
between 1974 and 1995, but the rates of decline differed significantly for
people with different levels of education. By 1995, people who had not
completed high school were more than twice as likely to smoke as those with
at least a college degree. (2)
* Diabetes, hypertension and heart disease are more common in individuals
with lower levels of education. The prevalence of these diseases varies also
by income, race and gender. (3)
* The rates at which excess body weight and obesity have increased differ by
level of educational attainment and gender. In general, however, individuals
with lower levels of education are more likely to be overweight or obese
than better-educated individuals. (2)
* Data from 2001 indicate that among adults ages 25-44 with less than a high
school education, the death rate (per 100,000 people) from motor vehicle
crashes was 27.3; for high school graduates, the rate was 20.7, and for
those with at least some college, the rate was 8.7. (4)
* In 1995, low birth weight and infant mortality were more common among
children born to less-educated mothers. Relationships between maternal
education and child health outcomes vary somewhat by racial and ethnic
group. (2)
* Mothers with less than 12 years of education are less likely to have
received care in the first trimester of pregnancy than mothers with 16 or
more years of education. Also, women with less than a high school diploma
are almost 10 times more likely to smoke during pregnancy. (2)
* In other countries around the world - both developed and developing - a
strong positive relationship exists between education and health: Better
health is associated with higher levels of education, regardless of whether
health is measured using morbidity and mortality rates or self-reports of
health status. (7)
* * *
Interview
Socioeconomic Disparities and Health: Identifying the Ways Education Plays a
Role
with Nancy E. Adler, Ph.D.
Nancy E. Adler, Ph.D., is professor of medical psychology and director of
the Center for Health and Community at the University of California, San
Francisco School of Medicine. She is also vice chair of the Department of
Psychiatry and director of the NIMH-funded training program in Psychology
and Medicine there. Adler serves as chair of the John D. and Catherine T.
MacArthur Research Network on Socioeconomic Status and Health.
Q/ How did socioeconomic status become a focus of research on disparities in
health outcomes?
A/ There are many factors that have led to more research in the United
States on the role socioeconomic status (SES) plays in health. Many
researchers were intrigued and challenged by the findings from the Whitehall
Study of British civil servants begun by Michael Marmot and colleagues in
the 1980s.
This study indicated that health improved with increasing civil service
status all the way to the highest occupational levels. This flew in the face
of assumptions that effects of socioeconomic status on health were due
solely to the adversities of poverty.
The study also made it clear that it was not possible to explain the
relationship between civil service status (an indicator of socioeconomic
status) through biology alone. The study prompted a lot of research on
psychological and social influences on health and illness.
On a more personal level, my work was affected greatly by an observation
made by Dr. Len Syme, who is emeritus professor of epidemiology at the
University of California, Berkeley, at a meeting of health researchers. We
asked him what he would want to know if he had to predict a person's health
status.
His response was that he would need just one piece of information: The most
powerful predictor of health status was SES, so this is what he would want
to know. This comment helped me and others move from seeing SES as something
that we needed to control for or adjust for in studies to seeing it as
something that needed to be studied in its own right.
Q/ What other effects did these factors have on research on SES and health?
A/ One critical step was to find out whether the relationship between SES
and health shown in the Whitehall studies existed in the United States also.
We found that enough studies had been conducted looking at SES and health in
the United States to demonstrate that socioeconomic status predicted health
at all levels.
This means that there wasn't just a threshold of SES - such as poverty level
- below which health was worse. Health improves as SES improves at all
levels. Researchers had to start looking at the ways that SES might affect
health, rather than simply seeing the issue as solely the effect of poverty.
It also meant that it was time to become more serious about how we define
SES.
Q/ Isn't the definition of socioeconomic status fairly straightforward?
A/ At one level, yes. Socioeconomic status encompasses education, income and
occupation. These components have been treated like they are interchangeable
by most researchers. Researchers in the United States have emphasized
education. In British studies, occupation has been emphasized.
Q/ What are the differences among the three factors?
A/ All three components provide a certain place in the social structure, but
each may bring different resources. An important task now, in the second
generation of SES-health research, is to disentangle the effects of the
different components and find out how and why they may operate in distinct
ways to affect health. For example, it's important to be able to identify
and understand what it is about education, and at what ages, that affects
health. We need to know these pathways to be able to intervene effectively.
(9)
Q/ What pathways have been identified linking education to health?
A/ Michael McGinnis and his colleagues (10) identified five factors that are
known to affect health and have estimated the magnitude of the impact of
each on premature mortality. SES affects four of the five factors: behavior,
which accounts for about 40 percent of premature mortality; social
circumstances, which account for about 15 percent; deficiencies in medical
care, about 10 percent; and environmental exposures, about 5 percent. These
determinants may overlap, but this gives some idea of order of magnitude of
the effects of each factor and will help us disentangle the ways that
education can affect health outcomes.
Q/ What specific knowledge exists about education's relationship with these
determinants?
A/ Let's start with health behaviors, which include behaviors such as
smoking, physical inactivity and a variety of other behaviors that affect
health. The frequency of almost every health behavior differs by level of
education. For example, the decline in smoking has been much steeper for
college-educated individuals than for people with less education. As a
result, we are beginning to see a relationship between education and lung
cancer rates, with increases for individuals with less education.
Q/ What about other pathways?
A/ In terms of medical care deficiencies, the less educated experience a
poorer quality of care. From the perspective of social circumstances and the
social environment, education can provide access to many things. These
include higher occupational status, a greater sense of control over your
life and increased social support - all of which may affect a person's
interactions with the health care system and choices they make.
Q/ What are other health benefits of higher levels of education?
A/ Education may make it possible to avoid stress and cope with stress
better when it happens. In terms of environmental exposures, individuals
with less education are more likely to have more hazardous jobs and, because
they have less money, to live in areas where they are exposed to toxins
(such as emissions from factories or freeways) and pathogens
(disease-causing organisms). The focus in the environmental justice movement
has been on unequal environmental exposure for poor and minority
communities, but education plays a role in occupation and therefore in
income.
Q/ How do genetics fit in this picture?
A/ Genetic predispositions are estimated to account for about 30 percent of
premature mortality. There are several ways that genetics could play a role.
One is that the same cluster of genes would lead both to education and to
health, or there could be a genetically determined third factor - such as
the ability to defer gratification or valuing a future time perspective -
that predicts education and health.
These are theoretically possible, but there is no empirical data showing
that either is true. It seems more likely that genetic vulnerability will
play a role in determining which disease a person gets who is exposed to
chronic stress or other adversities associated with lower education or SES.
Q/ What possible alternate explanations are there for the relationship
between SES and health?
A/ One fairly frequently suggested alternative explanation is that illness
causes decreases in income. The argument here is that health determines SES
rather than SES determining health. Health can affect socioeconomic status,
but this explanation is less convincing for education than it is for income.
Education levels are set much earlier in life and tend to change less than
income levels.
Q/ What about the role of one's childhood health in determining future SES?
A/ It is also possible that poor health during childhood can result in low
educational attainment and compromise children's development, leading to
lower SES in adulthood. Fortunately, the number of children with health
conditions this serious is relatively small. Thus, while there will be some
effect of health on education, the stronger effect is likely to be from
education to health.
Q/ What further study do you think will help advance our understanding of
the effects of education on health?
A/ We know that more education is better in terms of health. But we have to
distinguish among cognitive or intellectual ability, gains in skills and
capabilities, social networks and exposure to social norms, and credentials
(for example, earning a high school diploma or a college diploma) as the
result of education. The end results and policy implications are quite
different for these.
Q/ How does the quality of education factor in?
A/ We also don't know very much about the role that plays. For example, do
differences in the quality of education lead to differences in status? If
they do, how do quality and status affect the relationship between education
and health? Understanding education within the circumstances of our society
in general is also very important.
Q/ Where do you think research on education and health could lead?
A/ I hope that research on education and health will lead to a consideration
of education policy as health policy. The cost-benefit ratios for
educational interventions may change substantially when health effects are
factored in.
It's also important to think about education at all levels - from early
childhood through adulthood. A lot of emphasis has been placed on early
childhood education with good results, but we need better data to determine
the relative impact of education at different levels (for example,
interventions in early childhood education versus in secondary education).
Finally, if we take a global perspective, I think we'll see the highest
reward-to-cost ratio if a serious investment is made in the education of
mothers. In most parts of the developing world, this would mean educating
young women.
* * *
Interview
Education, Technology and Self-Management: Explaining the SES-Health
Gradient
with Dana P. Goldman, Ph.D.
Dana P. Goldman, Ph.D., is director of health economics at RAND in Santa
Monica, Calif., and an adjunct associate professor in the David Geffen
School of Medicine and the School of Public Health at the University of
California, Los Angeles. He received the 2002 National Institute for Health
Care Management Research and Educational Foundation award for excellence in
health policy.
Q/ What is the SES-health gradient?
A/ This is one of the most robust research findings in social science.
However one measures socioeconomic status (SES) - usually by measuring
income, education, or wealth - people with higher economic status have
better health outcomes. So when we look at the population as a whole, we see
that people at higher levels of SES appear to be in better health. This is
true whether health is measured using mortality, general health, or other
outcomes.
Q/ How does medical technology affect the relationship between socioeconomic
status and health?
A/ New medical technology makes it possible for people to be healthy in ways
that may have been considered almost unattainable in the past. New
technology also tends to lower the price of health care. One example of this
is highly active antiretroviral therapy (HAART) for the treatment of HIV.
This treatment was not available in the 1990s. It may seem expensive in
absolute terms, but it offers individuals the prospect of living - of making
HIV a chronic disease rather than a disease that is inevitably fatal in the
short term. That makes the cost of HAART therapy seem relatively low when
measured as the cost per unit of health improvement.
Q/ Who sees the health benefits of technology?
A/ Individuals with more education are better able to comply with treatment
and many new technologies make it possible for them to have better health.
This is also true in the case of HAART, which involves a very complicated
medication regimen. We've found that better adherence to the regimen is
associated with higher levels of socioeconomic status.
From this perspective, new medical technologies can lead to bigger
SES-related difference in health outcomes - there is a greater impact of SES
than we might see with other types of medical care. People with higher SES
tend to benefit more and earlier from certain types of new medical
technologies. One way to think about this is to think of new medical
technologies as a sale on health - people with higher SES are often situated
to take advantage of the sale and are likely to benefit more.
Q/ You refer to certain types of new medical technologies. Are there
exceptions to this?
A/ Yes, some medical technologies work the other way and tend to improve the
health of individuals with lower SES. Examples of this include
pharmaceuticals like the anti-hypertensives and beta blockers. These
basically take the place of health behaviors, like improving one's diet,
exercising and not smoking. The central issue is how medical technology
interacts with patient behavior - this is what affects health outcomes.
Q/ How does SES, or education in particular, affect the interaction between
medical technology and patient behavior?
A/ Education gives some benefit beyond that of income alone. Let's take the
treatment of diabetes as an example. Current treatments for diabetes involve
technologies such as oral medications, insulin injections or the use of an
insulin pump that require a lot of self-management on the part of the
patient. These include home monitoring of blood and glucose, changes in diet
and exercise, and a range of other behaviors to help keep blood glucose
under good control. From a purely health disparities perspective, these
treatments are likely to offer more benefit to educated patients who are
more likely to comply with fairly complex treatment regimens. (11)
On the other hand, a treatment for diabetes like a stem cell transplant that
restores insulin-producing capabilities to the pancreas is likely to be
neutral on education or SES, or to disproportionately benefit low-SES
individuals because it does not require the same kind of patient
self-management over the long haul.
Q/ But certain types of educational interventions are also likely to lead to
greater improvements in self-management for lower-SES individuals?
A/ Yes, our research indicates that in diabetic patients randomized to
intensive treatment or standard care, intensive monitoring has greater
benefits for individuals with less education. (11) This was the case even
when we looked at a population where all participants had at least a high
school diploma and we measured education up to a postgraduate degree. These
intensive treatment regimens led to better control of blood glucose levels
for less educated participants in comparison to a control group following a
common treatment regimen. We found that enforcing an intensive treatment
regimen had a much larger impact on individuals with fewer years of
education than on individuals with higher levels of education.
Q/ Did the treatment itself lead to the improvement, or did patients change
other behaviors that led to better control of their diabetes?
A/ We found that there were not any significant differences between the
treatment and control groups at any education level in behaviors such as
smoking or vigorous exercise. So the improved health among less-educated
individuals in the treatment group doesn't seem to be caused by changes in
personal behaviors that are likely to lead to better health outcomes. Better
adherence to a medically superior treatment regimen is what appears to have
led to improved health.
Q/ What is it about education that appears to affect patients'
self-management behaviors?
A/ We investigated the relationship between years of schooling, higher-level
reasoning (as measured by the Wechsler Adult Intelligence Score) and poor
self-maintenance behavior. We found that when the measure of higher-level
reasoning was included, the effect of years of schooling disappeared. This
suggests that the capacity for higher-level reasoning, rather than economic
resources, may play an important role in patient self-management. (11)
Q/ What conclusions can be drawn from your research?
A/ Better-educated people are healthier, but our studies indicate that the
SES gradient can be changed. This raises lots of questions about why
education is important and how to modify the relationship between SES and
health. Is higher-level reasoning a critical determinant of patients'
abilities to self-manage their care? Is it possible to design treatment
protocols that are based on the education level of the target population?
Can findings from these studies be generalized to other diseases and
conditions? Questions about how different medical technologies affect the
SES-health gradient, and how medical technologies and education interact to
produce health outcomes, also remain to be explored.
* * *
Heart Smart: The Link Between Education and Cardiovascular Disease
Researchers have found associations between education and a number of
specific diseases, with a connection for coronary heart disease particularly
well documented. Rates of mortality from CHD decline with increasing levels
of education (1) and education attainment has been linked to a number of
biological and behavioral risk factors for CHD. (12)
In a large study of middle-aged women in the 1980s, Karen Matthews, Ph.D.,
of the University of Pittsburgh School of Medicine and colleagues found that
women with lower levels of education were likely to also have a number of
biological, psychological and social risk factors for CHD. These include
higher systolic blood pressure, increased levels of LDL ("bad") cholesterol
and lower levels of HDL ("good") cholesterol, and higher blood glucose and
insulin levels.
Participants in the study with lower levels of education also reported more
fat in their diets and were less likely to be physically active. They were
also more likely to report that they smoked.
A lower level of education was also associated with higher levels of job
dissatisfaction, higher levels of depressive symptoms, lower self-esteem and
higher levels of anger. (12)
Dr. Matthews and her colleagues have also found that the incidence of aortic
calcification (an indicator of cardiovascular disease) is related to
education.
They have begun to examine how socioeconomic differences affect children's
health at different ages. This work shows, for example, that lower SES is
related to high blood pressure in childhood but not in adolescence, while
physical inactivity is associated with lower SES in adolescence but not in
childhood. (13) Matthews notes that children may start to develop unhealthy
behaviors fairly early and that by adolescence, young people begin to show
evidence of fibrous plaques, a type of damage to the arteries.
Matthews says these findings call for more study on the pathways that
connect education and the risk of cardiovascular disease, and investigations
of how the duration and quality of education improve cardiovascular disease
risk at different stages of development.
* * *
Definitions and Implications
1. What does education mean?
Education may seem like a fairly straightforward concept, but there are many
ways to think of education and many ways to measure it. The ways that
education is measured in most studies are quite basic. Measurements
typically include the number of years of education completed or whether a
subject obtained a specific educational credential, such as a high school
diploma or undergraduate degree.
To be able to answer questions about education's role in society and how it
is related to health, more sophisticated measures of education - and its
effects - are needed.
Education may cause changes in intellectual flexibility, leading to better
skills in using and evaluating information. In a highly technical health and
health care environment, this could mean that increasing the average level
of education would also lead to improved population health.
Education may also act as a kind of super-resource - an avenue to achieve
what is good and avoid what is bad in any particular social context. For
instance, education leads to credentials and skills that provide access to
prestige, jobs and money. On the negative side, disease may not be as
avoidable among people who have lower levels of education. Education can
also be viewed as a flexible resource. The pathways connecting education and
health can change or go away, and new ones may emerge. The role of
education, or of its different aspects, may also change or be different in
relation to different health outcomes. (14)
Although there is some evidence that more education leads to better health,
(7) most of the research on education and health is "correlational,"
indicating an association between the two factors, but not that either
causes the other. Many possible explanations for the relationship between
education and health are still being explored, with particular attention to
the ways in which education or the experience of being educated is
transformed or translated into specific health outcomes.
2. How does SES 'get under the skin'?
There are several ways that the process of education, or the level of
education achieved, could affect health. Some of these involve
education-related skills and their use specifically within health contexts.
The process of becoming educated may lead to increases in the ability to
understand and use complex information. Education may improve people's
abilities to manage their own health - to comply with medical advice and to
change behaviors that are bad for them. Education may also help individuals
feel more confident about using the health care system.
Many of these skills are aspects of health literacy, (15) which has been
defined in Healthy People 2010 as "the degree to which individuals have the
capacity to obtain, process and understand basic health information and
services needed to make appropriate health decisions."
The level of education completed or credentialing, in the form of a high
school diploma or college degree, may also open doors to many benefits and
resources that are associated with better health, including greater income
and safer occupations.
One area of research that holds promise is examining the relationships among
education, stress and health. Chronic stress has been shown to have a
negative effect on health. (16) Recent research suggests that education may
have a protective effect among adults who have a child being treated for
pediatric cancer. Researchers found that parents with higher levels of
education were less likely to experience the types of changes in immune
functioning experienced by parents with lower levels of education. The
processes or mechanisms by which education would trigger this protection
have not been identified, however. (17)
Studies, primarily of rats and non-human primates, have also documented the
changes in physiology and neurobiological development that can occur in very
young animals experiencing early deprivation or other negative early
experiences. (18,19) These studies, in combination, suggest that early
experiences - including learning and education - might be reflected in
biological and behavioral changes that affect health across the lifespan.
* * *
Resources
* For information about the Whitehall Study, contact:
Professor Michael Marmot
Department of Epidemiology & Public Health
University College London
1-19 Torrington Place
London WC1E 6BT, England
Tel: 44 171 391 1717
Fax: 44 171 813 0280
[log in to unmask]
http://www.workhealth.org/projects/pwhitew.html
* Health Canada-Santé Canada. Population Health Approach: What Determines
Health: "What Makes Canadians Healthy or Unhealthy?" [with underlying
premises and evidence table]:
http://www.hc-sc.gc.ca/hppb/phdd/determinants/e_determinants.html
* * *
BIBLIOGRAPHY
1. Steenland, K., Henley, J., Thun, M.. All-cause and cause-specific death
rates by educational status for 2 million people in two American Cancer
Society cohorts, 1959-1996. American Journal of Epidemiology,
2002:156:11-21.
2. Pamuk, E., Makuc, D., Heck, K., Reuben, C., Lochner, K. Socioeconomic
Status and Health Chartbook. Health, United States, 1998. Hyattsville, Md.:
NCHS, 1998. http://www.cdc.gov/nchs/data/hus/huscht98.pdf.
3. Paeratakul, S., Lovejoy, J.C., Ryan, D.H., Bray, G.A. The relation of
gender, race and socioeconomic status to obesity and obesity comorbidities
in a sample of U.S. adults. International Journal of Obesity,
2002;(26):1205-1210.
http://www.nature.com/ijo/journal/v26/n9/full/0802026a.html.
4. Centers for Disease Control and Prevention. Data 2010: the Healthy People
2010 Database, September 2002 Edition. Accessed via CDC Wonder at
http://wonder.cdc.gov/data2010.
5. Beckles, G.L.A., Thompson-Reid, P.E. Socioeconomic status of women with
diabetes - United States, 2000. MMWR Weekly, Feb. 22, 2002;51(07):147-8,
159.
6. Department of Health and Human Services, Office of the Surgeon General.
The Surgeon General's Call to Action to Prevent and Decrease Overweight and
Obesity: "Overweight and Obesity: At a Glance."
http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_glance.htm.
7. Case A. The primacy of education. Working paper #203, June 2001. Research
Program in Development Studies, Princeton University.
http://www.wws.princeton.edu/~rpds/working.htm.
8. Centers for Medicare and Medicaid Services, Office of the Actuary,
"National Health Expenditures, by Source of Funds and Type of Expenditure:
Calendar Years 1994-1998."
9. Adler, N.E., Newman, K. Socioeconomic disparities in health: pathways and
policies. Health Affairs, 2002;21(2):60-76.
10. McGinnis, J.M., Williams, P., Knickman, J.R. The case for more active
policy attention to health promotion. Health Affairs, 2002;21(2):78-93.
11. Goldman, D.P., Smith, J.P. Can patient self-management help explain the
SES health gradient? Proceedings of the National Academy of Sciences,
2002;99(16):10929-10934.
12. Matthews, K.A., Kelsey, S.F., Meilahn, E.N., Kuller, L.H., Wing, R.R.
Educational attainment and behavioral and biologic risk factors for coronary
heart disease in middle-aged women. American Journal of Epidemiology,
1989;129(6):1132-1144.
13. Chen, E., Matthews, K.A., Boyce, W.T. Socioeconomic differences in
children's health: how and why do these relationships change with age?
Psychological Bulletin, 2002;128(2):295-329.
14. Link, B. Workshop discussant. Education and Health: Building a Research
Agenda. Workshop sponsored by the Center for Health and Wellbeing, Princeton
University; MacArthur Network on Socioeconomic Status and Health, and the
National Institutes of Health. Washington, D.C. Oct. 17-18, 2002.
15. Kickbusch, I.S. Health literacy: addressing the health and education
divide. Health Promotion International, 2001;16(3):289-97.
16. McEwen, B.S. From molecules to mind. Stress, individual differences, and
the social environment. Annals of the New York Academy of Science,
2001;May:42-9.
17. Miller, G.E. All those years of education do pay off: education as a
buffer against the biological sequelae of chronic stress. Presented at
Education and Health: Building a Research Agenda. Workshop referenced in
citation 14 (see above).
18. Sánchez, M.M., Ladd, C.O., Plotsky, P.M. Early adverse experience as a
developmental risk factor for later psychopathology: evidence from rodent
and primate models. Development and Psychopathology, 2001;13:419-449.
19. Hertzman, C. Health and human society. American Scientist,
2001(Nov-Dec).
http://www.americanscientist.org/articles/01articles/Hertzman.html.
* * *
Facts of Life
Published monthly by the Health Behavior News Service
Editor
Kristina Campbell
Contributing Writer
Janice L. Genevro
Communications Associate
Will O'Bryan
Vice President, Public Affairs
Ira R. Allen
2000 Florida Ave., NW, Suite 210
Washington, DC 20009
Phone: 202-387-2829
Fax: 202-387-2857
[log in to unmask]
www.hbns.org
Copyright 2002
The Health Behavior News Service provides journalists with information,
interviews and commentary about an expanded view of health. It is operated
by the Center for the Advancement of Health, an independent nonprofit
organization that promotes greater recognition of how psychological, social,
behavioral, economic and environmental factors influence health and illness.
The Center receives core funding from the John D. and Catherine T. MacArthur
Foundation.
This edition of Facts of Life is one in a series exploring health
disparities and is published with support from the Office of Behavioral and
Social Science Research of the National Institutes of Health.
* * *
Next Issue:
Menopause
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