The Relationship Between Health, Education, and Health Literacy: Results From the Dutch Adult Literacy and Life Skills Survey

TLDR

Health literacy has been proposed as a mechanism linking education to health, yet empirical evidence for this hypothesis remains scarce. This study investigates whether health literacy mediates the effect of educational attainment on health status. Using the Health Activities and Literacy Scale on 5,136 Dutch adults aged 25–65 from the 2007 Adult Literacy and Life Skills Survey, linear regression models assessed mediation of education on self‑reported general, physical, and mental health measured by the SF‑12. Results show that health literacy partially mediates the relationship between low education and poorer self‑reported health, suggesting that enhancing health literacy could reduce education‑related health disparities.

Abstract

Health literacy has been put forward as a potential mechanism explaining the well-documented relationship between education and health. However, little empirical research has been undertaken to explore this hypothesis. The present study aims to study whether health literacy could be a pathway by which level of education affects health status. Health literacy was measured by the Health Activities and Literacy Scale, using data from a subsample of 5,136 adults between the ages of 25 and 65 years, gathered within the context of the 2007 Dutch Adult Literacy and Life Skills Survey. Linear regression analyses were used in separate models to estimate the extent to which health literacy mediates educational disparities in self-reported general health, physical health status, and mental health status as measured by the Short Form-12. Health literacy was found to partially mediate the association between low education and low self-reported health status. As such, improving health literacy may be a useful strategy for reducing disparities in health related to education, as health literacy appears to play a role in explaining the underlying mechanism driving the relationship between low level of education and poor health.