The School of Life: Do levels of education and skills influence the health risks of COVID-19?
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This article is part of a series in which OECD experts and thought leaders – from around the world and all parts of society – address the COVID-19 crisis, discussing and developing solutions now and for the future.
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Health is a complex issue. We measure the state of health in a country in terms of things like mortality rates, life expectancy or the physical and mental well-being of individuals and social groups. But each of these measures are influenced by so many different variables. Demographic factors, socio-economic conditions, lifestyles and behaviours, cultural norms and values, the quality of health care available – they all have an impact on health outcomes. To complicate things further, evidence shows that other, less obvious factors also come into play. Perhaps the most striking of these is the fact that education and skills seem to have a very strong relationship with health. Data from the OECD Survey of Adult Skills (PIAAC) show, for example, that the number of adults who report being in good health is 33 percentage points greater among those with high literacy skills and levels of education compared to those with lower levels. The relationship stands even after controlling for age or socio-economic status, indicating that more skilled individuals tend to live healthier lives. Longitudinal studies also show that developing skills in the early stages of life has a strong impact on health and mortality later into adulthood.
In contrast to the widespread assumption that the virus does not discriminate, first analyses of the available data now confirm that different parts of the population are affected in different ways. Analyses have so far focused predominantly on the role of basic demographics such as age, gender and national and regional dispersion – see, for example, the Eurostat data on the 140,000 excess deaths in Europe between weeks 10 and 17 of the pandemic. Other statistical reports also include ethnicity, while several research papers also focus on poverty and socio-economic variables. But very little has been said so far about the educational background of victims.
Among 21-65 year-olds, people with only primary or secondary school as their highest level of education were more than twice as likely to die than people with a tertiary education, after controlling for all other factors.
Some observers and researchers, however, have started to draw attention to the possibility of a relationship between education and COVID-19 mortality. The French newspaper Le Figaro (15 June 2020) devoted an article on the apparent country-level correlation between the impact of the pandemic and the average skill level in the population, as measured by the OECD Survey of Adult Skills. It was followed by a similar article in the French periodical Marianne about the relationship between the COVID-19 death toll and illiteracy rates. A few research papers are now starting to include educational attainment in their multivariate modelling of COVID-19 data. For example, a paper by a research team from Stockholm University on Swedish data found that individual survival rates were influenced by gender, income, marital status, location and migration status – but also educational attainment. This study found that among 21-65 year-olds, people with only primary or secondary school as their highest level of education were more than twice as likely to die than people with a tertiary education, after controlling for all other factors.
The interest in the role of education and skills for understanding the impact of COVID-19 may have been triggered by the apparent country-level correlation between how well a country is surviving the first wave of infections and its overall educational outlook or skills profile. High-skilled countries such as Korea, Japan, Finland, the Netherlands, New Zealand or Australia seem to have been doing relatively well, whereas countries such as Italy, Spain, France or the United States – i.e. countries with more mediocre skill levels in the OECD Survey of Adult Skills – have fared less well. Of course, the relationship is not linear and many other factors come into play as well, but the correlation is worth looking at in more detail.
Behavioural change is where education and skills come into play.
But how should we understand this relationship? The spread of the pandemic and the individual risk of being infected (and possibly dying) are to a large extent dependent on individual and social behaviour, such as social or physical distancing, limiting mobility, isolation and quarantine. Behavioural change is where education and skills come into play. First of all, there is a cognitive component in adapting one’s behaviour to fight the pandemic: people have to be able to decode the written information and have sufficient levels of reading comprehension to really get the message. Evidence presented in the media also includes a lot of quantitative data and statistics, which require numeracy skills to decipher. Pandemics like COVID-19 follow an exponential growth curve, and charts using log scales to show the numbers of infected people, hospitalisations and deaths are published daily. It is well-known that statistics often sit on the periphery of maths curricula in many countries, while exponential functions might only be taught in advanced maths classes.
In situations like this, it is critically important for people to understand that if 1 infected person infects 3 others per day (a low estimate), after 5 days 243 people will have been infected by that single individual. It is exactly this kind of mathematical knowledge and understanding that is needed to fully grasp why strict social distancing is necessary. Exponentials require a different mathematical understanding than linearity, which is much more prevalent in our daily numeracy tasks. It may be that many people – school-age kids as well as adults and elderly people – lack the basic literacy and numeracy skills to make sense of the information provided to them, and then to use that knowledge to change behaviour.
But cognitive skills are probably not the most important to drive behavioural change. We know from studies about other health hazards such as smoking, alcoholism or substance abuse that people may know perfectly well that their behaviour involves risks, but they still don’t change it. Behavioural change requires quite well-developed interpersonal, social and emotional skills, and well-developed ethical standards. People need to care about others – not only those in their immediate environment, but also those living far away, people they have never met. High levels of resilience, perseverance and responsibility are equally needed, as well as an understanding that one needs to do things for the greater good.
Also on the Forum Network: Resilience Against the Odds: Lessons from young people in the COVID-19 environment by Jack Dalrymple, CEO at Global Voices
It is too early to check empirically, but it seems plausible to suggest that countries, communities and social groups with relatively higher levels of cognitive and non-cognitive skills will be quicker and more successful in changing their behaviour. They may therefore be more successful in slowing the spread of the virus compared to those where the average skill level is lower. The speed of implementing protective measures, the rigour of their enforcement and also the social acceptance and execution among the population are, of course, highly relevant variables. But – especially for acceptance and execution– the cognitive and non-cognitive skills in the population also play a role.
This has important policy implications. In all countries, governments based their actions and instructions – sometimes against virological or epidemiological advice – on what they thought would be psychologically acceptable for the population. For example, they tried to avoid panic and announced measures in small steps, out of fear that people would not accept a sudden and drastic change in their daily routines. Not all governments had the instructional and communicative approach to patiently and painstakingly explain the necessity of social distancing measures from the very beginning. Appeals to socially responsible behaviour were abstract and often too difficult to understand by low-skilled people. Some of these communication errors led to confusion and consequently undermined compliance with the new regulations. A better understanding of how people with different cognitive and non-cognitive skills change their behaviour could lead to better communication and persuasion strategies and, hence, a more successful fight against this pandemic and any future pandemics we might face.
For more information: Skills Matter: Additional Results from the Survey of Adult Skills, the latest publication from the OECD's Programme for the International Assessment of Adult Competencies (PIAAC)
- OECD (2016), How are health and life satisfaction related to education? Education Indicators in Focus #47. https://doi.org/10.1787/6b8ca4c5-en
- P. Savelyev, K. Hong, and K. T. K. Tan (2020), "Understanding the Mechanisms Linking College Education with Longevity," Journal of Human Capital 0, no. ja (-Not available-). https://doi.org/10.1086/710221; OECD (2015)
- Skills for Social Progress. The Power of Social and Emotional Skills (Paris: OECD Publishing). https://doi.org/10.1787/23078731
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