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In Reply: I agree with Dr Muennig that education is a major determinant of health. It has been estimated that eliminating differences in mortality associated with education would avert 8 deaths for every life saved by medical advances.¹ I also agree that the influence of education on health and socioeconomic status probably exceeds that of income. But income is hardly irrelevant; it has independent effects on health status and is interconnected with education as both a mediator and by-product. For example, economic hardship makes learning difficult for students; preoccupies parents and families with concerns other than their children's study habits; makes tuition unaffordable; and chokes off tax revenue and other resources for schools, teachers, and infrastructure. Income is also a by-product of education: it boosts earnings and provides the means to purchase the commodities of good health (eg, insurance coverage, health care, nutritious foods).

Muennig is certainly correct that boosting . . . [Full Text of this Article]

Steven H. Woolf, MD, MPH
swoolf@vcu.edu
Department of Family Medicine
Virginia Commonwealth University
Richmond

RELATED LETTER

Health Consequences of Declining Incomes
Peter Muennig
JAMA. 2008;299(6):633.
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