About This Literature Summary
This summary of the literature on Enrollment in Higher Education as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Employment and High School Graduation literature summaries.
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Related Evidence-Based Resources (2)
Higher education is any type of education after high school (12th grade), including 2-year college (community college), certificate programs, 4-year college (bachelor programs), graduate programs, and professional programs. In 2020, 66.2 percent of high school graduates ages 16 to 24 years were enrolled in universities or colleges.1 This summary will focus on enrollment in and graduation from a 4-year college in relation to improved health and well-being.
Graduation from college has a positive impact on employment options.2,3 The risk of unemployment and underemployment is higher for those with less education.4 During the COVID-19 pandemic, the more education workers had, the more likely they were to keep their jobs and work remotely.5 Studies have shown that individuals with an associate’s degree are more likely to embark on a path of economic security and true economic success in comparison to those who only have taken certificate courses or have only completed high school.3,6 The average graduate with a bachelor’s degree will earn double what the average individual without a degree will make in their lifetime.4 Higher education helps people secure better-paying jobs with fewer safety hazards.3 Income from these employment opportunities may improve health by increasing people’s ability to accrue material resources, such as higher-quality housing, as well as psychosocial resources, such as higher social status.3,7
Overall, higher education can lead to improved health and well-being, as well as reduced risk for premature death.3,7,8,9 College graduates have better self-reported health than high school graduates,9 and individuals with more education are less likely to report conditions such as heart disease, high blood pressure, diabetes, anxiety, and depression.7 Furthermore, individuals with more education are more likely to exercise, drink less alcohol, and seek preventive health care when needed.2,3,7
Pursuing higher education later in life still offers health benefits. One study showed that people who received a bachelor’s degree at any point in life had better physical health than those who did not obtain any higher education degree.10 Regardless of how old someone is when returning to school, higher education can provide social interaction and intellectual stimulation.11
One factor that influences students’ decisions to attend college is the college preparation that their primary and secondary education offers.12 Additionally, the quality of this preparation influences students’ likelihood of graduating from college.13 High schools that lack financial resources rarely provide advanced or honors classes, making it difficult for students at those schools to be academically prepared for college-level work.12 Some high schools lack counselor support to help students select a college, apply for admission,14 and identify financial aid options.15 This process may affect a person’s decision to enroll in higher education.16
Another factor that influences enrollment and completion in higher education is a student’s social context.i,17 This shapes their beliefs about higher education as well as their ability to succeed in applying to and graduating from college.18,19,20 For instance, students whose parents have attended college benefit from their parents’ knowledge, experiences, and network. This helps them navigate the college admissions process,14 conform to academic expectations,18 and make informed decisions about their education.21 Additionally, while first-generation college students may not have the advantage of parental knowledge and experiences,21 they still name family support as a main source of encouragement for college enrollment.22
Institutional factors at colleges may impede enrollment and graduation. Public funding for colleges has been decreasing,23 leading to steep increases in tuition and student debt.24 Despite the availability of federal loans for many would-be students, the complexity of the financial aid process leads some students to forgo college.25 College admissions policies may prevent students who need remedial education from enrolling,26 and about a quarter of college students take remedial classes, potentially delaying graduation.27,28 Many students need assistance adjusting to college (e.g., selecting courses, applying for ongoing financial aid), but funding for these services may be limited, particularly at community colleges.29,30
Recent decades have seen a sharp increase in the racial/ethnic diversity of undergraduate enrollment at U.S. colleges and universities.31 However, certain racial/ethnic groups may face unique barriers to higher education. Undergraduate students from non-White racial/ethnic backgrounds, and particularly those who identify as Black, Hispanic, or American Indian/Alaska Native, generally show lower levels of academic persistenceii relative to White students.31, 32 African American and Hispanic individuals have lower college enrollment and graduation rates compared to White individuals,28 and Latino individuals are most likely to attend college part time, which reduces their odds of graduating.33 Several factors may contribute to these outcomes.
Black, Hispanic, Asian/Pacific Islander, American Indian/Alaska Native students, and non-Hispanic multiracial students may experience other stressors, such as discrimination and debt accumulation, that can affect academic outcomes.34 One study found that Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native students, as well as non-Hispanic multiracial students, experience discrimination at rates 2 to 4 times higher than White students. This study also determined that for 15 percent to 25 percent of students reporting discrimination, their academic performance was impacted.34 However, students attending a minority-serving institution (MSI) reported fewer experiences of discrimination. MSIs include higher education institutions that are geared toward minority groups, such as Historically Black Colleges and Universities (HBCUs), Tribal Colleges and Universities (TCUs), Hispanic-Serving Institutions (HSIs), and Asian American and Pacific Islander Serving Institutions (AAPISIs).35 Some racial/ethnic minority students attending predominately White colleges and universities (PWCUs) experience social isolation, but colleges can provide programs that help students from different racial/ethnic groups build social and cultural capital.30
Additionally, recent evidence has shown that African American college students accumulate more federal education debt than students of other ethnicities.36,37 Despite this, grants and loans help increase the likelihood of enrollment and completion, making higher education more accessible to all students.38 Grants and loans have made higher education more accessible to all students. One study documented that 80 percent of Hispanic students and 85 percent of American Indian/Alaska Native and Black students receive some type of grant. The same study found that 51 percent of Hispanic students, 62 percent of American Indian/Alaska Native students, and 72 percent of Black students receive some sort of loan.39
Although barriers to higher education remain, there are a number of strategies to address them. Strengthening the curriculum in primary and secondary public schools may better prepare students for college.12 Peer and faculty mentoring can help students apply to schools, secure financial aid, and feel a sense of community.29,30 Expanding access to subsidies such as scholarships and financial aid may increase college enrollment and completion.39
Further research is needed to identify how the association between higher education and health can be harnessed to improve health outcomes and reduce health disparities. Identifying, evaluating, and disseminating effective interventions to help students overcome barriers to college enrollment and graduation will be key. This additional evidence will facilitate public health efforts to address higher education as a social determinant of health.
i The American Psychological Association defines social context as the specific circumstance or general environment that serves as a social framework for individual or interpersonal behavior. This context frequently influences, at least to some degree, the actions and feelings that occur within it.
ii The National Student Clearinghouse Research Center defines persistence as “continued enrollment (or degree completion) at any higher education institution.”
U.S. Bureau of Labor Statistics. (2022). College enrollment and work activity of recent high school and college graduates summary. https://www.bls.gov/news.release/hsgec.nr0.htm
Ross, C. E., & Wu, C. L. (1995). The links between education and health. American Sociological Review, 719–745.
Kawachi, I., Adler, N. E., & Dow, W. H. (2010). Money, schooling, and health: Mechanisms and causal evidence. Annals of the New York Academy of Sciences, 1186(1), 56–68.
Hershbein, B., & Kearney, M. (2014). Major decisions: What graduates earn over their lifetimes. Hamilton Project.
Carnevale, A., Cheah, B., & Wenzinger, E. (2021). The college payoff: More education doesn’t always mean more earnings. Georgetown University Center on Education and the Workforce. https://cew.georgetown.edu/collegepayoff2021
Minaya, V., & Scott-Clayton, J. (2017). Labor market trajectories for community college graduates: New evidence spanning the great recession. A CAPSEE working paper. Center for Analysis of Postsecondary Education and Employment.
Cutler, D. M., & Lleras-Muney, A. (2006). Education and health: Evaluating theories and evidence (working paper no. 12352). National Bureau of Economic Research. https://doi.org/10.3386/w12352
Rogers, R. G., Everett, B. G., Zajacova, A., & Hummer, R. A. (2010). Educational degrees and adult mortality risk in the United States. Biodemography and Social Biology, 56(1), 80–99.
Goesling, B. (2007). The rising significance of education for health? Social Forces, 85(4), 1621–1644.
Vable, A. M., Duarte, C. D., Cohen, A. K., Glymour, M. M., Ream, R. K., & Yen, I. H. (2020). Does the type and timing of educational attainment influence physical health? A novel application of sequence analysis. American Journal of Epidemiology, 189(11), 1389–1401.
Elman, C. (1998). Guest editorial: Adult education, bringing in a sociological perspective. Research on Aging, 20(4), 379–390.
Haveman, R., & Smeeding, T. (2006). The role of higher education in social mobility. The Future of Children, 125–150.
Adelman, C. (2004). Principal indicators of student academic histories in postsecondary education, 1972–2000. U.S. Department of Education.
McDonough, P. M. (1997). Choosing colleges: How social class and schools structure opportunity. State University of New York Press.
McDonough, P. M. (2005). Counseling matters: Knowledge, assistance, and organizational commitment in college preparation. In W. G. Tierney, Z. B. Corwin, & J. E. Colyar (Eds.), Preparing for college: Nine elements of effective outreach (pp. 69–87). State University of New York Press.
Hahn, R. D., & Price, D. (2008). Promise lost: College-qualified students who don’t enroll in college. Institute for Higher Education Policy.
American Psychological Association. (n.d.). Social Context. APA Dictionary of Psychology. https://dictionary.apa.org/social-context
Bourdieu, P. (2018). Cultural reproduction and social reproduction. In R. Brown (Ed.), Knowledge, education, and cultural change (pp. 71–112). Routledge.
Perna, L. W. (2006). Studying college access and choice: A proposed conceptual model. In J. C. Smart (Ed.), Higher education (pp. 99–157). Springer, Dordrecht.
Nora, A. (2004). The role of habitus and cultural capital in choosing a college, transitioning from high school to higher education, and persisting in college among minority and nonminority students. Journal of Hispanic Higher Education, 3(2), 180–208.
Valadez, J. (1993). Cultural capital and its impact on the aspirations of nontraditional community college students. Community College Review, 21(3), 30–43.
Leon, A., & Medina, C. (2016). Success factors contributing to college enrollment among Latino migrant students [master’s thesis]. California State University.
Oliff, P., Palacios, V., Johnson, I., & Leachman, M. (2013). Recent deep state higher education cuts may harm students and the economy for years to come. Center on Budget and Policy Priorities, 19, 1–21.
Grinstein-Weiss, M., Perantie, D. C., Taylor, S. H., Guo, S., & Raghavan, R. (2016). Racial disparities in education debt burden among low- and moderate-income households. Children and Youth Services Review, 65, 166–174.
Bettinger, E. P., Long, B. T., Oreopoulos, P., & Sanbonmatsu, L. (2009). The role of simplification and information in college decisions: Results and implications from the H&R Block FAFSA experiment. An NCPR working paper. National Center for Postsecondary Research.
Attewell, P., Lavin, D., Domina, T., & Levey, T. (2006). New evidence on college remediation. Journal of Higher Education, 77(5), 886–924.
Parsad, B., Lewis, L., & Greene, B. (2003). Remedial education at degree-granting postsecondary institutions in fall 2000 (NCES 2004–010). U.S. Department of Education. National Center for Education Statistics. US Government Printing Office.
Horn, L., Berger, R., & Carroll, C. D. (2004). College persistence on the rise? Changes in 5-year degree completion and postsecondary persistence rates between 1994 and 2000: Postsecondary education descriptive analysis reports (NCES 2005-156). National Center for Education Statistics.
Brock, T. (2010). Young adults and higher education: Barriers and breakthroughs to success. The Future of Children, 109–132.
Ovink, S. M., & Veazey, B. D. (2011). More than “getting us through”: A case study in cultural capital enrichment of underrepresented minority undergraduates. Research in Higher Education, 52(4), 370–394.
Musu-Gillette, L., De Brey, C., McFarland, J., Hussar, W., Sonnenberg, W., & Wilkinson-Flicker, S. (2017). Status and trends in the education of racial and ethnic groups 2017 (NCES 2017-051). National Center for Education Statistics.
National Student Clearinghouse Research Center. (2015) Persistence & retention — 2015. https://nscresearchcenter.org/snapshotreport-persistenceretention18/
Fry, R. (2002). Latinos in higher education: Many enroll, too few graduate. Pew Hispanic Center.
Stevens, C., Liu, C. H., & Chen, J. A. (2018). Racial/ethnic disparities in U.S. college students’ experience: Discrimination as an impediment to academic performance. Journal of American College Health, 66(7), 665–673.
U.S. Department of the Interior, Office of Diversity, Inclusion and Civil Rights. (2015). Minority serving institutions program. https://www.doi.gov/pmb/eeo/doi-minority-serving-institutions-program
Houle, J. N., & Addo, F. R. (2019). Racial disparities in student debt and the reproduction of the fragile black middle class. Sociology of Race and Ethnicity, 5(4), 562–577.
Kim, J., Chatterjee, S., Young, J., & Moon, U. J. (2017). The cost of access: Racial disparities in student loan burdens of young adults. College Student Journal, 51(1), 99–114.
Baker, A. R., Andrews, B. D., & McDaniel, A. (2017). The impact of student loans on college access, completion, and returns. Sociology Compass, 11(6), e12480.
Dynarski, S. (2008). Building the stock of college-educated labor. Journal of Human Resources, 43(3), 576–610.