Better health, but growing social and health inequalities among young adults in Germany due to educational expansion? A counterfactual mediation analysis

Abstract

Purpose Based on theoretical and empirical work on the significance of school education for health, this study examines the influence of educational expansion on self-rated health (SRH) and the development of social and health inequalities between educational groups among young adults in Germany. Methods We used data from the German Socio-Economic Panel study from 1995 to 2020, focusing on individuals aged 25–39 years. Health was measured using the single item ‘self-rated health’. Social inequalities between educational groups were examined in terms of professional position, unemployment rates and household income. Logistic regression analyses were applied to examine health trends. The Relative and Slope Index of Inequality (RII/SII) were calculated to examine the development of social and health inequalities. The influence of school education, professional position, unemployment rates and income on the health trends was analysed using causal mediation analysis. Results We found a beneficial effect of educational expansion on SRH of young adults. At the same time, social and health inequalities have increased between educational groups in terms of relative and absolute measures of inequalities. The deterioration in health of young adults with low education could be partly explained by the increase in low-skilled jobs and low incomes. Conclusions Our findings suggest that a high educational attainment is becoming increasingly important for success in the labor market and good SRH. Young adults with a low level of education are becoming a smaller but increasingly vulnerable group, which poses challenges for future prevention.