A critical review of the literature on the relationship between school quality and health inequalities

Robust evidence suggesting a strong association between greater educational attainment, betterhealth and lower mortality, has led to speculation that the quality of schooling can also have effectson health. This review critically summarises findings from 15 studies in a growing area of researchconcerning the effects of school quality on health. Findings suggested positive, long-term benefits ofhigh-quality pre-school. Other findings suggested that higher teacher wages, lower pupil–teacherratios, a longer school year, and higher college selectivity had mostly positive long-term effects onhealth and mortality. Several studies found that school quality modified the effect of years of completededucation on various health outcomes. Some measures of school quality including smallerclass size in relation to mortality, and higher college selectivity in the case of smoking were not consistentlyrelated to better health. While studies varied in their consistency and significance, theweight of the evidence together, suggests that some health inequalities over the life course wereexplained partly by differences in school quality. This may be related to improved cognition, occupationalcharacteristics, and the incomes of those exposed to better quality schooling. Direct healthknowledge and behaviour may also play a role